|
DESTRUCTION BENIGN LESIONS 15/>
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 17111
|
| Hospital Charge Code |
17111
|
| Min. Negotiated Rate |
$349.50 |
| Max. Negotiated Rate |
$466.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$456.68
|
| Rate for Payer: Beech Street Commercial |
$442.70
|
| Rate for Payer: Cash Price |
$326.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$452.02
|
| Rate for Payer: Cigna of WY Commercial |
$456.68
|
| Rate for Payer: First Choice Health Commercial |
$419.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$442.70
|
| Rate for Payer: HealthUtah PPO |
$466.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$452.02
|
| Rate for Payer: One Health Plan of WY PPO |
$456.68
|
| Rate for Payer: PacificSource Commercial |
$419.40
|
| Rate for Payer: PHCS PPO |
$442.70
|
| Rate for Payer: Three Rivers PPO |
$349.50
|
| Rate for Payer: United Healthcare Commercial |
$405.42
|
| Rate for Payer: WINHealth Partners Commercial |
$396.10
|
|
|
DESTRUCTION BENIGN LESIONS UP TO 14
|
Professional
|
Both
|
$399.00
|
|
|
Service Code
|
HCPCS 17110
|
| Hospital Charge Code |
17110
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$391.02
|
| Rate for Payer: Aetna of WY Medicare |
$67.18
|
| Rate for Payer: Beech Street Commercial |
$379.05
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: Cash Price |
$279.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$387.03
|
| Rate for Payer: Cigna of WY Commercial |
$391.02
|
| Rate for Payer: First Choice Health Commercial |
$359.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$379.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$67.18
|
| Rate for Payer: HealthUtah PPO |
$399.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$387.03
|
| Rate for Payer: Multiplan Medicare/VA |
$57.10
|
| Rate for Payer: One Health Plan of WY PPO |
$391.02
|
| Rate for Payer: PacificSource Commercial |
$359.10
|
| Rate for Payer: PHCS PPO |
$379.05
|
| Rate for Payer: Three Rivers PPO |
$299.25
|
| Rate for Payer: TriWest Veterans Administration |
$67.18
|
| Rate for Payer: United Healthcare Commercial |
$347.13
|
| Rate for Payer: United Healthcare Medicare |
$67.18
|
| Rate for Payer: WINHealth Partners Commercial |
$339.15
|
|
|
DESTRUCTION INTERNAL HEMORRHOID THERMAL ENERGY
|
Professional
|
Both
|
$777.00
|
|
|
Service Code
|
HCPCS 46930
|
| Hospital Charge Code |
46930
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$777.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$761.46
|
| Rate for Payer: Aetna of WY Medicare |
$148.00
|
| Rate for Payer: Beech Street Commercial |
$738.15
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$753.69
|
| Rate for Payer: Cigna of WY Commercial |
$761.46
|
| Rate for Payer: First Choice Health Commercial |
$699.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$738.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$148.00
|
| Rate for Payer: HealthUtah PPO |
$777.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$753.69
|
| Rate for Payer: Multiplan Medicare/VA |
$125.80
|
| Rate for Payer: One Health Plan of WY PPO |
$761.46
|
| Rate for Payer: PacificSource Commercial |
$699.30
|
| Rate for Payer: PHCS PPO |
$738.15
|
| Rate for Payer: Three Rivers PPO |
$582.75
|
| Rate for Payer: TriWest Veterans Administration |
$148.00
|
| Rate for Payer: United Healthcare Commercial |
$675.99
|
| Rate for Payer: United Healthcare Medicare |
$148.00
|
| Rate for Payer: WINHealth Partners Commercial |
$660.45
|
|
|
DESTRUCTION LESIONS VULVA EXTENSIVE
|
Professional
|
Both
|
$1,605.00
|
|
|
Service Code
|
HCPCS 56515
|
| Hospital Charge Code |
56515
|
| Min. Negotiated Rate |
$175.33 |
| Max. Negotiated Rate |
$1,605.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,572.90
|
| Rate for Payer: Aetna of WY Medicare |
$206.27
|
| Rate for Payer: Beech Street Commercial |
$1,524.75
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: Cash Price |
$1,123.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,556.85
|
| Rate for Payer: Cigna of WY Commercial |
$1,572.90
|
| Rate for Payer: First Choice Health Commercial |
$1,444.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,524.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$206.27
|
| Rate for Payer: HealthUtah PPO |
$1,605.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,556.85
|
| Rate for Payer: Multiplan Medicare/VA |
$175.33
|
| Rate for Payer: One Health Plan of WY PPO |
$1,572.90
|
| Rate for Payer: PacificSource Commercial |
$1,444.50
|
| Rate for Payer: PHCS PPO |
$1,524.75
|
| Rate for Payer: Three Rivers PPO |
$1,203.75
|
| Rate for Payer: TriWest Veterans Administration |
$206.27
|
| Rate for Payer: United Healthcare Commercial |
$1,396.35
|
| Rate for Payer: United Healthcare Medicare |
$206.27
|
| Rate for Payer: WINHealth Partners Commercial |
$1,364.25
|
|
|
DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/<
|
Professional
|
Both
|
$433.00
|
|
|
Service Code
|
HCPCS 17280
|
| Hospital Charge Code |
17280
|
| Min. Negotiated Rate |
$71.70 |
| Max. Negotiated Rate |
$433.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$424.34
|
| Rate for Payer: Aetna of WY Medicare |
$84.35
|
| Rate for Payer: Beech Street Commercial |
$411.35
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: Cash Price |
$303.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.01
|
| Rate for Payer: Cigna of WY Commercial |
$424.34
|
| Rate for Payer: First Choice Health Commercial |
$389.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$411.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.35
|
| Rate for Payer: HealthUtah PPO |
$433.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.01
|
| Rate for Payer: Multiplan Medicare/VA |
$71.70
|
| Rate for Payer: One Health Plan of WY PPO |
$424.34
|
| Rate for Payer: PacificSource Commercial |
$389.70
|
| Rate for Payer: PHCS PPO |
$411.35
|
| Rate for Payer: Three Rivers PPO |
$324.75
|
| Rate for Payer: TriWest Veterans Administration |
$84.35
|
| Rate for Payer: United Healthcare Commercial |
$376.71
|
| Rate for Payer: United Healthcare Medicare |
$84.35
|
| Rate for Payer: WINHealth Partners Commercial |
$368.05
|
|
|
DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/<
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 17270
|
| Hospital Charge Code |
17270
|
| Min. Negotiated Rate |
$78.79 |
| Max. Negotiated Rate |
$703.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$688.94
|
| Rate for Payer: Aetna of WY Medicare |
$92.69
|
| Rate for Payer: Beech Street Commercial |
$667.85
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: Cash Price |
$492.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$681.91
|
| Rate for Payer: Cigna of WY Commercial |
$688.94
|
| Rate for Payer: First Choice Health Commercial |
$632.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$667.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$92.69
|
| Rate for Payer: HealthUtah PPO |
$703.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$681.91
|
| Rate for Payer: Multiplan Medicare/VA |
$78.79
|
| Rate for Payer: One Health Plan of WY PPO |
$688.94
|
| Rate for Payer: PacificSource Commercial |
$632.70
|
| Rate for Payer: PHCS PPO |
$667.85
|
| Rate for Payer: Three Rivers PPO |
$527.25
|
| Rate for Payer: TriWest Veterans Administration |
$92.69
|
| Rate for Payer: United Healthcare Commercial |
$611.61
|
| Rate for Payer: United Healthcare Medicare |
$92.69
|
| Rate for Payer: WINHealth Partners Commercial |
$597.55
|
|
|
DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/<
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 17260
|
| Hospital Charge Code |
17260
|
| Min. Negotiated Rate |
$58.28 |
| Max. Negotiated Rate |
$350.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$343.00
|
| Rate for Payer: Aetna of WY Medicare |
$68.56
|
| Rate for Payer: Beech Street Commercial |
$332.50
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: Cash Price |
$245.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$339.50
|
| Rate for Payer: Cigna of WY Commercial |
$343.00
|
| Rate for Payer: First Choice Health Commercial |
$315.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$332.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.56
|
| Rate for Payer: HealthUtah PPO |
$350.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$339.50
|
| Rate for Payer: Multiplan Medicare/VA |
$58.28
|
| Rate for Payer: One Health Plan of WY PPO |
$343.00
|
| Rate for Payer: PacificSource Commercial |
$315.00
|
| Rate for Payer: PHCS PPO |
$332.50
|
| Rate for Payer: Three Rivers PPO |
$262.50
|
| Rate for Payer: TriWest Veterans Administration |
$68.56
|
| Rate for Payer: United Healthcare Commercial |
$304.50
|
| Rate for Payer: United Healthcare Medicare |
$68.56
|
| Rate for Payer: WINHealth Partners Commercial |
$297.50
|
|
|
DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
HCPCS 17261
|
| Hospital Charge Code |
17261
|
| Min. Negotiated Rate |
$71.98 |
| Max. Negotiated Rate |
$434.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$425.32
|
| Rate for Payer: Aetna of WY Medicare |
$84.68
|
| Rate for Payer: Beech Street Commercial |
$412.30
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: Cash Price |
$303.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$420.98
|
| Rate for Payer: Cigna of WY Commercial |
$425.32
|
| Rate for Payer: First Choice Health Commercial |
$390.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$412.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$84.68
|
| Rate for Payer: HealthUtah PPO |
$434.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$420.98
|
| Rate for Payer: Multiplan Medicare/VA |
$71.98
|
| Rate for Payer: One Health Plan of WY PPO |
$425.32
|
| Rate for Payer: PacificSource Commercial |
$390.60
|
| Rate for Payer: PHCS PPO |
$412.30
|
| Rate for Payer: Three Rivers PPO |
$325.50
|
| Rate for Payer: TriWest Veterans Administration |
$84.68
|
| Rate for Payer: United Healthcare Commercial |
$377.58
|
| Rate for Payer: United Healthcare Medicare |
$84.68
|
| Rate for Payer: WINHealth Partners Commercial |
$368.90
|
|
|
DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM
|
Professional
|
Both
|
$558.00
|
|
|
Service Code
|
HCPCS 17262
|
| Hospital Charge Code |
17262
|
| Min. Negotiated Rate |
$90.89 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$546.84
|
| Rate for Payer: Aetna of WY Medicare |
$106.93
|
| Rate for Payer: Beech Street Commercial |
$530.10
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$541.26
|
| Rate for Payer: Cigna of WY Commercial |
$546.84
|
| Rate for Payer: First Choice Health Commercial |
$502.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$530.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$106.93
|
| Rate for Payer: HealthUtah PPO |
$558.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$541.26
|
| Rate for Payer: Multiplan Medicare/VA |
$90.89
|
| Rate for Payer: One Health Plan of WY PPO |
$546.84
|
| Rate for Payer: PacificSource Commercial |
$502.20
|
| Rate for Payer: PHCS PPO |
$530.10
|
| Rate for Payer: Three Rivers PPO |
$418.50
|
| Rate for Payer: TriWest Veterans Administration |
$106.93
|
| Rate for Payer: United Healthcare Commercial |
$485.46
|
| Rate for Payer: United Healthcare Medicare |
$106.93
|
| Rate for Payer: WINHealth Partners Commercial |
$474.30
|
|
|
DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
HCPCS 17263
|
| Hospital Charge Code |
17263
|
| Min. Negotiated Rate |
$100.49 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$608.58
|
| Rate for Payer: Aetna of WY Medicare |
$118.22
|
| Rate for Payer: Beech Street Commercial |
$589.95
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$602.37
|
| Rate for Payer: Cigna of WY Commercial |
$608.58
|
| Rate for Payer: First Choice Health Commercial |
$558.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$589.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$118.22
|
| Rate for Payer: HealthUtah PPO |
$621.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$602.37
|
| Rate for Payer: Multiplan Medicare/VA |
$100.49
|
| Rate for Payer: One Health Plan of WY PPO |
$608.58
|
| Rate for Payer: PacificSource Commercial |
$558.90
|
| Rate for Payer: PHCS PPO |
$589.95
|
| Rate for Payer: Three Rivers PPO |
$465.75
|
| Rate for Payer: TriWest Veterans Administration |
$118.22
|
| Rate for Payer: United Healthcare Commercial |
$540.27
|
| Rate for Payer: United Healthcare Medicare |
$118.22
|
| Rate for Payer: WINHealth Partners Commercial |
$527.85
|
|
|
DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 17264
|
| Hospital Charge Code |
17264
|
| Min. Negotiated Rate |
$107.30 |
| Max. Negotiated Rate |
$661.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$647.78
|
| Rate for Payer: Aetna of WY Medicare |
$126.24
|
| Rate for Payer: Beech Street Commercial |
$627.95
|
| Rate for Payer: Cash Price |
$462.70
|
| Rate for Payer: Cash Price |
$462.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$641.17
|
| Rate for Payer: Cigna of WY Commercial |
$647.78
|
| Rate for Payer: First Choice Health Commercial |
$594.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$627.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.24
|
| Rate for Payer: HealthUtah PPO |
$661.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$641.17
|
| Rate for Payer: Multiplan Medicare/VA |
$107.30
|
| Rate for Payer: One Health Plan of WY PPO |
$647.78
|
| Rate for Payer: PacificSource Commercial |
$594.90
|
| Rate for Payer: PHCS PPO |
$627.95
|
| Rate for Payer: Three Rivers PPO |
$495.75
|
| Rate for Payer: TriWest Veterans Administration |
$126.24
|
| Rate for Payer: United Healthcare Commercial |
$575.07
|
| Rate for Payer: United Healthcare Medicare |
$126.24
|
| Rate for Payer: WINHealth Partners Commercial |
$561.85
|
|
|
DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
HCPCS 17266
|
| Hospital Charge Code |
17266
|
| Min. Negotiated Rate |
$125.66 |
| Max. Negotiated Rate |
$782.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$766.36
|
| Rate for Payer: Aetna of WY Medicare |
$147.83
|
| Rate for Payer: Beech Street Commercial |
$742.90
|
| Rate for Payer: Cash Price |
$547.40
|
| Rate for Payer: Cash Price |
$547.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$758.54
|
| Rate for Payer: Cigna of WY Commercial |
$766.36
|
| Rate for Payer: First Choice Health Commercial |
$703.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$742.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$147.83
|
| Rate for Payer: HealthUtah PPO |
$782.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$758.54
|
| Rate for Payer: Multiplan Medicare/VA |
$125.66
|
| Rate for Payer: One Health Plan of WY PPO |
$766.36
|
| Rate for Payer: PacificSource Commercial |
$703.80
|
| Rate for Payer: PHCS PPO |
$742.90
|
| Rate for Payer: Three Rivers PPO |
$586.50
|
| Rate for Payer: TriWest Veterans Administration |
$147.83
|
| Rate for Payer: United Healthcare Commercial |
$680.34
|
| Rate for Payer: United Healthcare Medicare |
$147.83
|
| Rate for Payer: WINHealth Partners Commercial |
$664.70
|
|
|
DESTRUCTION PREMALIGNANT LESION 15/>
|
Professional
|
Both
|
$487.00
|
|
|
Service Code
|
HCPCS 17004
|
| Hospital Charge Code |
17004
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$487.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$477.26
|
| Rate for Payer: Aetna of WY Medicare |
$95.31
|
| Rate for Payer: Beech Street Commercial |
$462.65
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: Cash Price |
$340.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$472.39
|
| Rate for Payer: Cigna of WY Commercial |
$477.26
|
| Rate for Payer: First Choice Health Commercial |
$438.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$462.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$95.31
|
| Rate for Payer: HealthUtah PPO |
$487.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$472.39
|
| Rate for Payer: Multiplan Medicare/VA |
$81.01
|
| Rate for Payer: One Health Plan of WY PPO |
$477.26
|
| Rate for Payer: PacificSource Commercial |
$438.30
|
| Rate for Payer: PHCS PPO |
$462.65
|
| Rate for Payer: Three Rivers PPO |
$365.25
|
| Rate for Payer: TriWest Veterans Administration |
$95.31
|
| Rate for Payer: United Healthcare Commercial |
$423.69
|
| Rate for Payer: United Healthcare Medicare |
$95.31
|
| Rate for Payer: WINHealth Partners Commercial |
$413.95
|
|
|
DESTRUCTION PREMALIGNANT LESION 1ST
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 17000
|
| Hospital Charge Code |
17000
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$262.64
|
| Rate for Payer: Aetna of WY Medicare |
$53.84
|
| Rate for Payer: Beech Street Commercial |
$254.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: Cash Price |
$187.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$259.96
|
| Rate for Payer: Cigna of WY Commercial |
$262.64
|
| Rate for Payer: First Choice Health Commercial |
$241.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$254.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.84
|
| Rate for Payer: HealthUtah PPO |
$268.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$259.96
|
| Rate for Payer: Multiplan Medicare/VA |
$45.76
|
| Rate for Payer: One Health Plan of WY PPO |
$262.64
|
| Rate for Payer: PacificSource Commercial |
$241.20
|
| Rate for Payer: PHCS PPO |
$254.60
|
| Rate for Payer: Three Rivers PPO |
$201.00
|
| Rate for Payer: TriWest Veterans Administration |
$53.84
|
| Rate for Payer: United Healthcare Commercial |
$233.16
|
| Rate for Payer: United Healthcare Medicare |
$53.84
|
| Rate for Payer: WINHealth Partners Commercial |
$227.80
|
|
|
DESTRUCTION PREMALIGNANT LESION 2-14 EA
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 17003
|
| Hospital Charge Code |
17003
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.54
|
| Rate for Payer: Aetna of WY Medicare |
$1.96
|
| Rate for Payer: Beech Street Commercial |
$21.85
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: Cash Price |
$16.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$22.31
|
| Rate for Payer: Cigna of WY Commercial |
$22.54
|
| Rate for Payer: First Choice Health Commercial |
$20.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.96
|
| Rate for Payer: HealthUtah PPO |
$23.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$22.31
|
| Rate for Payer: Multiplan Medicare/VA |
$1.67
|
| Rate for Payer: One Health Plan of WY PPO |
$22.54
|
| Rate for Payer: PacificSource Commercial |
$20.70
|
| Rate for Payer: PHCS PPO |
$21.85
|
| Rate for Payer: Three Rivers PPO |
$17.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$20.01
|
| Rate for Payer: United Healthcare Medicare |
$1.96
|
| Rate for Payer: WINHealth Partners Commercial |
$19.55
|
|
|
DESTRUCTION RECTAL TUMOR TRANSANAL APPROACH
|
Professional
|
Both
|
$3,340.00
|
|
|
Service Code
|
HCPCS 45190
|
| Hospital Charge Code |
45190
|
| Min. Negotiated Rate |
$572.17 |
| Max. Negotiated Rate |
$3,340.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,273.20
|
| Rate for Payer: Aetna of WY Medicare |
$673.14
|
| Rate for Payer: Beech Street Commercial |
$3,173.00
|
| Rate for Payer: Cash Price |
$2,338.00
|
| Rate for Payer: Cash Price |
$2,338.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,239.80
|
| Rate for Payer: Cigna of WY Commercial |
$3,273.20
|
| Rate for Payer: First Choice Health Commercial |
$3,006.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,173.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$673.14
|
| Rate for Payer: HealthUtah PPO |
$3,340.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,239.80
|
| Rate for Payer: Multiplan Medicare/VA |
$572.17
|
| Rate for Payer: One Health Plan of WY PPO |
$3,273.20
|
| Rate for Payer: PacificSource Commercial |
$3,006.00
|
| Rate for Payer: PHCS PPO |
$3,173.00
|
| Rate for Payer: Three Rivers PPO |
$2,505.00
|
| Rate for Payer: TriWest Veterans Administration |
$673.14
|
| Rate for Payer: United Healthcare Commercial |
$2,905.80
|
| Rate for Payer: United Healthcare Medicare |
$673.14
|
| Rate for Payer: WINHealth Partners Commercial |
$2,839.00
|
|
|
DESTRUCTION VAGINAL LESIONS SIMPLE
|
Professional
|
Both
|
$2,856.00
|
|
|
Service Code
|
HCPCS 57061
|
| Hospital Charge Code |
57061
|
| Min. Negotiated Rate |
$95.81 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,798.88
|
| Rate for Payer: Aetna of WY Medicare |
$112.72
|
| Rate for Payer: Beech Street Commercial |
$2,713.20
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: Cash Price |
$1,999.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,770.32
|
| Rate for Payer: Cigna of WY Commercial |
$2,798.88
|
| Rate for Payer: First Choice Health Commercial |
$2,570.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,713.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.72
|
| Rate for Payer: HealthUtah PPO |
$2,856.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,770.32
|
| Rate for Payer: Multiplan Medicare/VA |
$95.81
|
| Rate for Payer: One Health Plan of WY PPO |
$2,798.88
|
| Rate for Payer: PacificSource Commercial |
$2,570.40
|
| Rate for Payer: PHCS PPO |
$2,713.20
|
| Rate for Payer: Three Rivers PPO |
$2,142.00
|
| Rate for Payer: TriWest Veterans Administration |
$112.72
|
| Rate for Payer: United Healthcare Commercial |
$2,484.72
|
| Rate for Payer: United Healthcare Medicare |
$112.72
|
| Rate for Payer: WINHealth Partners Commercial |
$2,427.60
|
|
|
DEXAMETHASONE 2 MG TABLET [11934]
|
Facility
|
IP
|
$2.86
|
|
|
Service Code
|
HCPCS J8540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.80
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.75
|
| Rate for Payer: Altius Commercial |
$2.75
|
| Rate for Payer: Beech Street Commercial |
$2.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.77
|
| Rate for Payer: Cigna of WY Commercial |
$2.80
|
| Rate for Payer: Entrust Commercial |
$2.72
|
| Rate for Payer: First Choice Health Commercial |
$2.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.89
|
| Rate for Payer: HealthUtah PPO |
$2.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.79
|
| Rate for Payer: One Health Plan of WY PPO |
$2.80
|
| Rate for Payer: PacificSource Commercial |
$2.57
|
| Rate for Payer: PHCS PPO |
$2.80
|
| Rate for Payer: Three Rivers PPO |
$2.14
|
| Rate for Payer: TriWest Veterans Administration |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$2.49
|
| Rate for Payer: United Healthcare Medicare |
$1.89
|
| Rate for Payer: WINHealth Partners Commercial |
$2.72
|
| Rate for Payer: Wise Provider Network Commercial |
$2.72
|
|
|
DEXAMETHASONE 2 MG TABLET [11934]
|
Facility
|
OP
|
$2.86
|
|
|
Service Code
|
HCPCS J8540
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2.86 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.80
|
| Rate for Payer: Aetna of WY Medicare |
$1.89
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.75
|
| Rate for Payer: Altius Commercial |
$2.75
|
| Rate for Payer: Beech Street Commercial |
$2.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$2.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.77
|
| Rate for Payer: Cigna of WY Commercial |
$2.80
|
| Rate for Payer: Entrust Commercial |
$2.72
|
| Rate for Payer: First Choice Health Commercial |
$2.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.72
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.66
|
| Rate for Payer: HealthUtah PPO |
$2.86
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.77
|
| Rate for Payer: Multiplan Medicare/VA |
$1.58
|
| Rate for Payer: One Health Plan of WY PPO |
$2.80
|
| Rate for Payer: PacificSource Commercial |
$2.57
|
| Rate for Payer: PHCS PPO |
$2.80
|
| Rate for Payer: Three Rivers PPO |
$2.14
|
| Rate for Payer: TriWest Veterans Administration |
$1.66
|
| Rate for Payer: United Healthcare Commercial |
$2.49
|
| Rate for Payer: United Healthcare Medicare |
$1.66
|
| Rate for Payer: WINHealth Partners Commercial |
$2.80
|
| Rate for Payer: Wise Provider Network Commercial |
$2.72
|
|
|
DEXAMETHASONE SODIUM PHOS
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J1100
|
| Hospital Charge Code |
J1100
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8.82
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Beech Street Commercial |
$8.55
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$8.73
|
| Rate for Payer: Cigna of WY Commercial |
$8.82
|
| Rate for Payer: First Choice Health Commercial |
$8.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$9.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8.73
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$8.82
|
| Rate for Payer: PacificSource Commercial |
$8.10
|
| Rate for Payer: PHCS PPO |
$8.55
|
| Rate for Payer: Three Rivers PPO |
$6.75
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$7.83
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$8.55
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [17072]
|
Facility
|
IP
|
$25.80
|
|
|
Service Code
|
HCPCS J1100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.49
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.77
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.12
|
| Rate for Payer: Altius Commercial |
$18.12
|
| Rate for Payer: Altius Commercial |
$24.77
|
| Rate for Payer: Beech Street Commercial |
$25.28
|
| Rate for Payer: Beech Street Commercial |
$18.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.18
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.03
|
| Rate for Payer: Cigna of WY Commercial |
$25.28
|
| Rate for Payer: Cigna of WY Commercial |
$18.49
|
| Rate for Payer: Entrust Commercial |
$17.93
|
| Rate for Payer: Entrust Commercial |
$24.51
|
| Rate for Payer: First Choice Health Commercial |
$17.93
|
| Rate for Payer: First Choice Health Commercial |
$24.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.03
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.45
|
| Rate for Payer: HealthUtah PPO |
$25.80
|
| Rate for Payer: HealthUtah PPO |
$18.87
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.03
|
| Rate for Payer: Multiplan Medicare/VA |
$16.18
|
| Rate for Payer: Multiplan Medicare/VA |
$11.83
|
| Rate for Payer: One Health Plan of WY PPO |
$25.28
|
| Rate for Payer: One Health Plan of WY PPO |
$18.49
|
| Rate for Payer: PacificSource Commercial |
$23.22
|
| Rate for Payer: PacificSource Commercial |
$16.98
|
| Rate for Payer: PHCS PPO |
$18.49
|
| Rate for Payer: PHCS PPO |
$25.28
|
| Rate for Payer: Three Rivers PPO |
$14.15
|
| Rate for Payer: Three Rivers PPO |
$19.35
|
| Rate for Payer: TriWest Veterans Administration |
$17.03
|
| Rate for Payer: TriWest Veterans Administration |
$12.45
|
| Rate for Payer: United Healthcare Commercial |
$16.42
|
| Rate for Payer: United Healthcare Commercial |
$22.45
|
| Rate for Payer: United Healthcare Medicare |
$17.03
|
| Rate for Payer: United Healthcare Medicare |
$12.45
|
| Rate for Payer: WINHealth Partners Commercial |
$17.93
|
| Rate for Payer: WINHealth Partners Commercial |
$24.51
|
| Rate for Payer: Wise Provider Network Commercial |
$17.93
|
| Rate for Payer: Wise Provider Network Commercial |
$24.51
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML INJECTION SOLUTION [17072]
|
Facility
|
OP
|
$25.80
|
|
|
Service Code
|
HCPCS J1100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.22 |
| Max. Negotiated Rate |
$25.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$25.28
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.49
|
| Rate for Payer: Aetna of WY Medicare |
$17.03
|
| Rate for Payer: Aetna of WY Medicare |
$12.45
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$24.77
|
| Rate for Payer: Altius Commercial |
$24.77
|
| Rate for Payer: Altius Commercial |
$18.12
|
| Rate for Payer: Beech Street Commercial |
$18.49
|
| Rate for Payer: Beech Street Commercial |
$25.28
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$21.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.49
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$18.06
|
| Rate for Payer: ChoiceCare Network Commercial |
$25.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.30
|
| Rate for Payer: Cigna of WY Commercial |
$18.49
|
| Rate for Payer: Cigna of WY Commercial |
$25.28
|
| Rate for Payer: Entrust Commercial |
$24.51
|
| Rate for Payer: Entrust Commercial |
$17.93
|
| Rate for Payer: First Choice Health Commercial |
$17.93
|
| Rate for Payer: First Choice Health Commercial |
$24.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.93
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$24.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.96
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.94
|
| Rate for Payer: HealthUtah PPO |
$18.87
|
| Rate for Payer: HealthUtah PPO |
$25.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$25.03
|
| Rate for Payer: Multiplan Medicare/VA |
$14.22
|
| Rate for Payer: Multiplan Medicare/VA |
$10.40
|
| Rate for Payer: One Health Plan of WY PPO |
$18.49
|
| Rate for Payer: One Health Plan of WY PPO |
$25.28
|
| Rate for Payer: PacificSource Commercial |
$23.22
|
| Rate for Payer: PacificSource Commercial |
$16.98
|
| Rate for Payer: PHCS PPO |
$18.49
|
| Rate for Payer: PHCS PPO |
$25.28
|
| Rate for Payer: Three Rivers PPO |
$14.15
|
| Rate for Payer: Three Rivers PPO |
$19.35
|
| Rate for Payer: TriWest Veterans Administration |
$14.96
|
| Rate for Payer: TriWest Veterans Administration |
$10.94
|
| Rate for Payer: United Healthcare Commercial |
$16.42
|
| Rate for Payer: United Healthcare Commercial |
$22.45
|
| Rate for Payer: United Healthcare Medicare |
$14.96
|
| Rate for Payer: United Healthcare Medicare |
$10.94
|
| Rate for Payer: WINHealth Partners Commercial |
$18.49
|
| Rate for Payer: WINHealth Partners Commercial |
$25.28
|
| Rate for Payer: Wise Provider Network Commercial |
$17.93
|
| Rate for Payer: Wise Provider Network Commercial |
$24.51
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [42773]
|
Facility
|
IP
|
$41.25
|
|
|
Service Code
|
HCPCS J1100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.60
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
| Rate for Payer: Altius Commercial |
$21.12
|
| Rate for Payer: Altius Commercial |
$39.60
|
| Rate for Payer: Beech Street Commercial |
$40.42
|
| Rate for Payer: Beech Street Commercial |
$21.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.87
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.01
|
| Rate for Payer: Cigna of WY Commercial |
$40.42
|
| Rate for Payer: Cigna of WY Commercial |
$21.56
|
| Rate for Payer: Entrust Commercial |
$20.90
|
| Rate for Payer: Entrust Commercial |
$39.19
|
| Rate for Payer: First Choice Health Commercial |
$20.90
|
| Rate for Payer: First Choice Health Commercial |
$39.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.52
|
| Rate for Payer: HealthUtah PPO |
$41.25
|
| Rate for Payer: HealthUtah PPO |
$22.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.01
|
| Rate for Payer: Multiplan Medicare/VA |
$25.86
|
| Rate for Payer: Multiplan Medicare/VA |
$13.79
|
| Rate for Payer: One Health Plan of WY PPO |
$40.42
|
| Rate for Payer: One Health Plan of WY PPO |
$21.56
|
| Rate for Payer: PacificSource Commercial |
$37.12
|
| Rate for Payer: PacificSource Commercial |
$19.80
|
| Rate for Payer: PHCS PPO |
$21.56
|
| Rate for Payer: PHCS PPO |
$40.42
|
| Rate for Payer: Three Rivers PPO |
$16.50
|
| Rate for Payer: Three Rivers PPO |
$30.94
|
| Rate for Payer: TriWest Veterans Administration |
$27.22
|
| Rate for Payer: TriWest Veterans Administration |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
| Rate for Payer: United Healthcare Medicare |
$27.22
|
| Rate for Payer: United Healthcare Medicare |
$14.52
|
| Rate for Payer: WINHealth Partners Commercial |
$20.90
|
| Rate for Payer: WINHealth Partners Commercial |
$39.19
|
| Rate for Payer: Wise Provider Network Commercial |
$20.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.19
|
|
|
DEXAMETHASONE SODIUM PHOSPHATE (PF) 10 MG/ML INJECTION SOLUTION [42773]
|
Facility
|
OP
|
$41.25
|
|
|
Service Code
|
HCPCS J1100
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$40.42
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$21.56
|
| Rate for Payer: Aetna of WY Medicare |
$27.22
|
| Rate for Payer: Aetna of WY Medicare |
$14.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$39.60
|
| Rate for Payer: Altius Commercial |
$39.60
|
| Rate for Payer: Altius Commercial |
$21.12
|
| Rate for Payer: Beech Street Commercial |
$21.56
|
| Rate for Payer: Beech Street Commercial |
$40.42
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$33.87
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.06
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$40.01
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.34
|
| Rate for Payer: Cigna of WY Commercial |
$21.56
|
| Rate for Payer: Cigna of WY Commercial |
$40.42
|
| Rate for Payer: Entrust Commercial |
$39.19
|
| Rate for Payer: Entrust Commercial |
$20.90
|
| Rate for Payer: First Choice Health Commercial |
$20.90
|
| Rate for Payer: First Choice Health Commercial |
$39.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$20.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$39.19
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.92
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.76
|
| Rate for Payer: HealthUtah PPO |
$22.00
|
| Rate for Payer: HealthUtah PPO |
$41.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$40.01
|
| Rate for Payer: Multiplan Medicare/VA |
$22.73
|
| Rate for Payer: Multiplan Medicare/VA |
$12.12
|
| Rate for Payer: One Health Plan of WY PPO |
$21.56
|
| Rate for Payer: One Health Plan of WY PPO |
$40.42
|
| Rate for Payer: PacificSource Commercial |
$37.12
|
| Rate for Payer: PacificSource Commercial |
$19.80
|
| Rate for Payer: PHCS PPO |
$21.56
|
| Rate for Payer: PHCS PPO |
$40.42
|
| Rate for Payer: Three Rivers PPO |
$16.50
|
| Rate for Payer: Three Rivers PPO |
$30.94
|
| Rate for Payer: TriWest Veterans Administration |
$23.92
|
| Rate for Payer: TriWest Veterans Administration |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$19.14
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
| Rate for Payer: United Healthcare Medicare |
$23.92
|
| Rate for Payer: United Healthcare Medicare |
$12.76
|
| Rate for Payer: WINHealth Partners Commercial |
$21.56
|
| Rate for Payer: WINHealth Partners Commercial |
$40.42
|
| Rate for Payer: Wise Provider Network Commercial |
$20.90
|
| Rate for Payer: Wise Provider Network Commercial |
$39.19
|
|
|
DEXMEDETOMIDINE 100 MCG/ML INTRAVENOUS SOLUTION [13530]
|
Facility
|
IP
|
$28.50
|
|
|
Service Code
|
NDC 5515020902
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.87 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$27.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$27.36
|
| Rate for Payer: Altius Commercial |
$27.36
|
| Rate for Payer: Beech Street Commercial |
$27.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$19.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$27.64
|
| Rate for Payer: Cigna of WY Commercial |
$27.93
|
| Rate for Payer: Entrust Commercial |
$27.08
|
| Rate for Payer: First Choice Health Commercial |
$27.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$27.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$18.81
|
| Rate for Payer: HealthUtah PPO |
$28.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$27.64
|
| Rate for Payer: Multiplan Medicare/VA |
$17.87
|
| Rate for Payer: One Health Plan of WY PPO |
$27.93
|
| Rate for Payer: PacificSource Commercial |
$25.65
|
| Rate for Payer: PHCS PPO |
$27.93
|
| Rate for Payer: Three Rivers PPO |
$21.38
|
| Rate for Payer: TriWest Veterans Administration |
$18.81
|
| Rate for Payer: United Healthcare Commercial |
$24.80
|
| Rate for Payer: United Healthcare Medicare |
$18.81
|
| Rate for Payer: WINHealth Partners Commercial |
$27.08
|
| Rate for Payer: Wise Provider Network Commercial |
$27.08
|
|
