|
CHARGING SYSTEM KIT SC-6412-3
|
Facility
|
IP
|
$8,575.00
|
|
| Hospital Charge Code |
2800188
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,969.21 |
| Max. Negotiated Rate |
$8,575.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,403.50
|
| Rate for Payer: Aetna of WY Medicare |
$5,488.00
|
| Rate for Payer: Altius Commercial |
$8,232.00
|
| Rate for Payer: Beech Street Commercial |
$8,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$8,317.75
|
| Rate for Payer: Cash Price |
$6,002.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$8,317.75
|
| Rate for Payer: Cigna of WY Commercial |
$8,403.50
|
| Rate for Payer: Entrust Commercial |
$8,146.25
|
| Rate for Payer: First Choice Health Commercial |
$8,146.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8,146.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,230.75
|
| Rate for Payer: HealthUtah PPO |
$8,575.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$8,317.75
|
| Rate for Payer: Multiplan Medicare/VA |
$4,969.21
|
| Rate for Payer: One Health Plan of WY PPO |
$8,403.50
|
| Rate for Payer: PacificSource Commercial |
$7,717.50
|
| Rate for Payer: PHCS PPO |
$8,403.50
|
| Rate for Payer: Three Rivers PPO |
$6,431.25
|
| Rate for Payer: TriWest Veterans Administration |
$5,230.75
|
| Rate for Payer: United Healthcare Commercial |
$8,189.12
|
| Rate for Payer: United Healthcare Medicare |
$5,230.75
|
| Rate for Payer: WINHealth Partners Commercial |
$8,146.25
|
| Rate for Payer: Wise Provider Network Commercial |
$8,146.25
|
|
|
CHEMICAL CAUTERIZATION OF GRANULATION TISSUE
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 17250
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$158.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.84
|
| Rate for Payer: Aetna of WY Medicare |
$36.32
|
| Rate for Payer: Beech Street Commercial |
$150.10
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: Cash Price |
$110.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$153.26
|
| Rate for Payer: Cigna of WY Commercial |
$154.84
|
| Rate for Payer: First Choice Health Commercial |
$142.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$150.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$36.32
|
| Rate for Payer: HealthUtah PPO |
$158.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$153.26
|
| Rate for Payer: Multiplan Medicare/VA |
$30.87
|
| Rate for Payer: One Health Plan of WY PPO |
$154.84
|
| Rate for Payer: PacificSource Commercial |
$142.20
|
| Rate for Payer: PHCS PPO |
$150.10
|
| Rate for Payer: Three Rivers PPO |
$118.50
|
| Rate for Payer: TriWest Veterans Administration |
$36.32
|
| Rate for Payer: United Healthcare Commercial |
$150.10
|
| Rate for Payer: WINHealth Partners Commercial |
$134.30
|
|
|
CHEMO BONDED TEXIUM 10ML SYR
|
Facility
|
OP
|
$7.85
|
|
| Hospital Charge Code |
2050095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.69
|
| Rate for Payer: Aetna of WY Medicare |
$5.18
|
| Rate for Payer: Altius Commercial |
$7.54
|
| Rate for Payer: Beech Street Commercial |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.61
|
| Rate for Payer: Cigna of WY Commercial |
$7.69
|
| Rate for Payer: Entrust Commercial |
$7.46
|
| Rate for Payer: First Choice Health Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.47
|
| Rate for Payer: HealthUtah PPO |
$7.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.61
|
| Rate for Payer: Multiplan Medicare/VA |
$4.25
|
| Rate for Payer: One Health Plan of WY PPO |
$7.69
|
| Rate for Payer: PacificSource Commercial |
$7.06
|
| Rate for Payer: PHCS PPO |
$7.69
|
| Rate for Payer: Three Rivers PPO |
$5.89
|
| Rate for Payer: TriWest Veterans Administration |
$4.47
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$4.47
|
| Rate for Payer: WINHealth Partners Commercial |
$7.69
|
| Rate for Payer: Wise Provider Network Commercial |
$7.46
|
|
|
CHEMO BONDED TEXIUM 10ML SYR
|
Facility
|
IP
|
$7.85
|
|
| Hospital Charge Code |
2050095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.55 |
| Max. Negotiated Rate |
$7.85 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7.69
|
| Rate for Payer: Aetna of WY Medicare |
$5.02
|
| Rate for Payer: Altius Commercial |
$7.54
|
| Rate for Payer: Beech Street Commercial |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.61
|
| Rate for Payer: Cash Price |
$5.49
|
| Rate for Payer: ChoiceCare Network Commercial |
$7.61
|
| Rate for Payer: Cigna of WY Commercial |
$7.69
|
| Rate for Payer: Entrust Commercial |
$7.46
|
| Rate for Payer: First Choice Health Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.79
|
| Rate for Payer: HealthUtah PPO |
$7.85
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7.61
|
| Rate for Payer: Multiplan Medicare/VA |
$4.55
|
| Rate for Payer: One Health Plan of WY PPO |
$7.69
|
| Rate for Payer: PacificSource Commercial |
$7.06
|
| Rate for Payer: PHCS PPO |
$7.69
|
| Rate for Payer: Three Rivers PPO |
$5.89
|
| Rate for Payer: TriWest Veterans Administration |
$4.79
|
| Rate for Payer: United Healthcare Commercial |
$7.50
|
| Rate for Payer: United Healthcare Medicare |
$4.79
|
| Rate for Payer: WINHealth Partners Commercial |
$7.46
|
| Rate for Payer: Wise Provider Network Commercial |
$7.46
|
|
|
CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 64643
|
| Min. Negotiated Rate |
$56.42 |
| Max. Negotiated Rate |
$314.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$307.72
|
| Rate for Payer: Aetna of WY Medicare |
$66.38
|
| Rate for Payer: Beech Street Commercial |
$298.30
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: Cash Price |
$219.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$304.58
|
| Rate for Payer: Cigna of WY Commercial |
$307.72
|
| Rate for Payer: First Choice Health Commercial |
$282.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$298.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$66.38
|
| Rate for Payer: HealthUtah PPO |
$314.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$304.58
|
| Rate for Payer: Multiplan Medicare/VA |
$56.42
|
| Rate for Payer: One Health Plan of WY PPO |
$307.72
|
| Rate for Payer: PacificSource Commercial |
$282.60
|
| Rate for Payer: PHCS PPO |
$298.30
|
| Rate for Payer: Three Rivers PPO |
$235.50
|
| Rate for Payer: TriWest Veterans Administration |
$66.38
|
| Rate for Payer: United Healthcare Commercial |
$298.30
|
| Rate for Payer: WINHealth Partners Commercial |
$266.90
|
|
|
CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA
|
Professional
|
Both
|
$544.00
|
|
|
Service Code
|
HCPCS 64616
|
| Min. Negotiated Rate |
$88.35 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$533.12
|
| Rate for Payer: Aetna of WY Medicare |
$103.94
|
| Rate for Payer: Beech Street Commercial |
$516.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: Cash Price |
$380.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$527.68
|
| Rate for Payer: Cigna of WY Commercial |
$533.12
|
| Rate for Payer: First Choice Health Commercial |
$489.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$516.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.94
|
| Rate for Payer: HealthUtah PPO |
$544.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$527.68
|
| Rate for Payer: Multiplan Medicare/VA |
$88.35
|
| Rate for Payer: One Health Plan of WY PPO |
$533.12
|
| Rate for Payer: PacificSource Commercial |
$489.60
|
| Rate for Payer: PHCS PPO |
$516.80
|
| Rate for Payer: Three Rivers PPO |
$408.00
|
| Rate for Payer: TriWest Veterans Administration |
$103.94
|
| Rate for Payer: United Healthcare Commercial |
$516.80
|
| Rate for Payer: WINHealth Partners Commercial |
$462.40
|
|
|
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES
|
Professional
|
Both
|
$720.00
|
|
|
Service Code
|
HCPCS 64647
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$705.60
|
| Rate for Payer: Aetna of WY Medicare |
$126.59
|
| Rate for Payer: Beech Street Commercial |
$684.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: Cash Price |
$504.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$698.40
|
| Rate for Payer: Cigna of WY Commercial |
$705.60
|
| Rate for Payer: First Choice Health Commercial |
$648.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$684.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$126.59
|
| Rate for Payer: HealthUtah PPO |
$720.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$698.40
|
| Rate for Payer: Multiplan Medicare/VA |
$107.60
|
| Rate for Payer: One Health Plan of WY PPO |
$705.60
|
| Rate for Payer: PacificSource Commercial |
$648.00
|
| Rate for Payer: PHCS PPO |
$684.00
|
| Rate for Payer: Three Rivers PPO |
$540.00
|
| Rate for Payer: TriWest Veterans Administration |
$126.59
|
| Rate for Payer: United Healthcare Commercial |
$684.00
|
| Rate for Payer: WINHealth Partners Commercial |
$612.00
|
|
|
CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES
|
Professional
|
Both
|
$629.00
|
|
|
Service Code
|
HCPCS 64646
|
| Min. Negotiated Rate |
$93.58 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.42
|
| Rate for Payer: Aetna of WY Medicare |
$110.09
|
| Rate for Payer: Beech Street Commercial |
$597.55
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: Cash Price |
$440.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$610.13
|
| Rate for Payer: Cigna of WY Commercial |
$616.42
|
| Rate for Payer: First Choice Health Commercial |
$566.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.09
|
| Rate for Payer: HealthUtah PPO |
$629.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$610.13
|
| Rate for Payer: Multiplan Medicare/VA |
$93.58
|
| Rate for Payer: One Health Plan of WY PPO |
$616.42
|
| Rate for Payer: PacificSource Commercial |
$566.10
|
| Rate for Payer: PHCS PPO |
$597.55
|
| Rate for Payer: Three Rivers PPO |
$471.75
|
| Rate for Payer: TriWest Veterans Administration |
$110.09
|
| Rate for Payer: United Healthcare Commercial |
$597.55
|
| Rate for Payer: WINHealth Partners Commercial |
$534.65
|
|
|
CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
HCPCS 64642
|
| Min. Negotiated Rate |
$86.72 |
| Max. Negotiated Rate |
$470.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$460.60
|
| Rate for Payer: Aetna of WY Medicare |
$102.02
|
| Rate for Payer: Beech Street Commercial |
$446.50
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: Cash Price |
$329.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$455.90
|
| Rate for Payer: Cigna of WY Commercial |
$460.60
|
| Rate for Payer: First Choice Health Commercial |
$423.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$446.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$102.02
|
| Rate for Payer: HealthUtah PPO |
$470.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$455.90
|
| Rate for Payer: Multiplan Medicare/VA |
$86.72
|
| Rate for Payer: One Health Plan of WY PPO |
$460.60
|
| Rate for Payer: PacificSource Commercial |
$423.00
|
| Rate for Payer: PHCS PPO |
$446.50
|
| Rate for Payer: Three Rivers PPO |
$352.50
|
| Rate for Payer: TriWest Veterans Administration |
$102.02
|
| Rate for Payer: United Healthcare Commercial |
$446.50
|
| Rate for Payer: WINHealth Partners Commercial |
$399.50
|
|
|
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
HCPCS 64615
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$538.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$527.24
|
| Rate for Payer: Aetna of WY Medicare |
$115.77
|
| Rate for Payer: Beech Street Commercial |
$511.10
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: Cash Price |
$376.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$521.86
|
| Rate for Payer: Cigna of WY Commercial |
$527.24
|
| Rate for Payer: First Choice Health Commercial |
$484.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$511.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.77
|
| Rate for Payer: HealthUtah PPO |
$538.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$521.86
|
| Rate for Payer: Multiplan Medicare/VA |
$98.40
|
| Rate for Payer: One Health Plan of WY PPO |
$527.24
|
| Rate for Payer: PacificSource Commercial |
$484.20
|
| Rate for Payer: PHCS PPO |
$511.10
|
| Rate for Payer: Three Rivers PPO |
$403.50
|
| Rate for Payer: TriWest Veterans Administration |
$115.77
|
| Rate for Payer: United Healthcare Commercial |
$511.10
|
| Rate for Payer: WINHealth Partners Commercial |
$457.30
|
|
|
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL
|
Professional
|
Both
|
$576.00
|
|
|
Service Code
|
HCPCS 64612
|
| Min. Negotiated Rate |
$98.02 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$564.48
|
| Rate for Payer: Aetna of WY Medicare |
$115.32
|
| Rate for Payer: Beech Street Commercial |
$547.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$558.72
|
| Rate for Payer: Cigna of WY Commercial |
$564.48
|
| Rate for Payer: First Choice Health Commercial |
$518.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$547.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$115.32
|
| Rate for Payer: HealthUtah PPO |
$576.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$558.72
|
| Rate for Payer: Multiplan Medicare/VA |
$98.02
|
| Rate for Payer: One Health Plan of WY PPO |
$564.48
|
| Rate for Payer: PacificSource Commercial |
$518.40
|
| Rate for Payer: PHCS PPO |
$547.20
|
| Rate for Payer: Three Rivers PPO |
$432.00
|
| Rate for Payer: TriWest Veterans Administration |
$115.32
|
| Rate for Payer: United Healthcare Commercial |
$547.20
|
| Rate for Payer: WINHealth Partners Commercial |
$489.60
|
|
|
CHEMO LOW-SORB 20 DROP
|
Facility
|
IP
|
$16.35
|
|
| Hospital Charge Code |
2050084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.47 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.02
|
| Rate for Payer: Aetna of WY Medicare |
$10.46
|
| Rate for Payer: Altius Commercial |
$15.70
|
| Rate for Payer: Beech Street Commercial |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.02
|
| Rate for Payer: Entrust Commercial |
$15.53
|
| Rate for Payer: First Choice Health Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.97
|
| Rate for Payer: HealthUtah PPO |
$16.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.86
|
| Rate for Payer: Multiplan Medicare/VA |
$9.47
|
| Rate for Payer: One Health Plan of WY PPO |
$16.02
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.02
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.97
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare |
$9.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.53
|
| Rate for Payer: Wise Provider Network Commercial |
$15.53
|
|
|
CHEMO LOW-SORB 20 DROP
|
Facility
|
OP
|
$16.35
|
|
| Hospital Charge Code |
2050084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.85 |
| Max. Negotiated Rate |
$16.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.02
|
| Rate for Payer: Aetna of WY Medicare |
$10.79
|
| Rate for Payer: Altius Commercial |
$15.70
|
| Rate for Payer: Beech Street Commercial |
$16.02
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.86
|
| Rate for Payer: Cash Price |
$11.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.86
|
| Rate for Payer: Cigna of WY Commercial |
$16.02
|
| Rate for Payer: Entrust Commercial |
$15.53
|
| Rate for Payer: First Choice Health Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.32
|
| Rate for Payer: HealthUtah PPO |
$16.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.86
|
| Rate for Payer: Multiplan Medicare/VA |
$8.85
|
| Rate for Payer: One Health Plan of WY PPO |
$16.02
|
| Rate for Payer: PacificSource Commercial |
$14.72
|
| Rate for Payer: PHCS PPO |
$16.02
|
| Rate for Payer: Three Rivers PPO |
$12.26
|
| Rate for Payer: TriWest Veterans Administration |
$9.32
|
| Rate for Payer: United Healthcare Commercial |
$15.61
|
| Rate for Payer: United Healthcare Medicare |
$9.32
|
| Rate for Payer: WINHealth Partners Commercial |
$16.02
|
| Rate for Payer: Wise Provider Network Commercial |
$15.53
|
|
|
CHEMO NEEDLE FREE VALVE 2000E
|
Facility
|
IP
|
$1.23
|
|
| Hospital Charge Code |
2050098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.71 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.79
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.75
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.71
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
| Rate for Payer: United Healthcare Medicare |
$0.75
|
| Rate for Payer: WINHealth Partners Commercial |
$1.17
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
CHEMO NEEDLE FREE VALVE 2000E
|
Facility
|
OP
|
$1.23
|
|
| Hospital Charge Code |
2050098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.21
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Altius Commercial |
$1.18
|
| Rate for Payer: Beech Street Commercial |
$1.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$0.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.19
|
| Rate for Payer: Cigna of WY Commercial |
$1.21
|
| Rate for Payer: Entrust Commercial |
$1.17
|
| Rate for Payer: First Choice Health Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.70
|
| Rate for Payer: HealthUtah PPO |
$1.23
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.19
|
| Rate for Payer: Multiplan Medicare/VA |
$0.67
|
| Rate for Payer: One Health Plan of WY PPO |
$1.21
|
| Rate for Payer: PacificSource Commercial |
$1.11
|
| Rate for Payer: PHCS PPO |
$1.21
|
| Rate for Payer: Three Rivers PPO |
$0.92
|
| Rate for Payer: TriWest Veterans Administration |
$0.70
|
| Rate for Payer: United Healthcare Commercial |
$1.17
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
| Rate for Payer: WINHealth Partners Commercial |
$1.21
|
| Rate for Payer: Wise Provider Network Commercial |
$1.17
|
|
|
CHEMO SHEILD 20MM MV0520
|
Facility
|
IP
|
$24.16
|
|
| Hospital Charge Code |
2050091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.68
|
| Rate for Payer: Aetna of WY Medicare |
$15.46
|
| Rate for Payer: Altius Commercial |
$23.19
|
| Rate for Payer: Beech Street Commercial |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.44
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.44
|
| Rate for Payer: Cigna of WY Commercial |
$23.68
|
| Rate for Payer: Entrust Commercial |
$22.95
|
| Rate for Payer: First Choice Health Commercial |
$22.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.74
|
| Rate for Payer: HealthUtah PPO |
$24.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.44
|
| Rate for Payer: Multiplan Medicare/VA |
$14.00
|
| Rate for Payer: One Health Plan of WY PPO |
$23.68
|
| Rate for Payer: PacificSource Commercial |
$21.74
|
| Rate for Payer: PHCS PPO |
$23.68
|
| Rate for Payer: Three Rivers PPO |
$18.12
|
| Rate for Payer: TriWest Veterans Administration |
$14.74
|
| Rate for Payer: United Healthcare Commercial |
$23.07
|
| Rate for Payer: United Healthcare Medicare |
$14.74
|
| Rate for Payer: WINHealth Partners Commercial |
$22.95
|
| Rate for Payer: Wise Provider Network Commercial |
$22.95
|
|
|
CHEMO SHEILD 20MM MV0520
|
Facility
|
OP
|
$24.16
|
|
| Hospital Charge Code |
2050091
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.08 |
| Max. Negotiated Rate |
$24.16 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.68
|
| Rate for Payer: Aetna of WY Medicare |
$15.95
|
| Rate for Payer: Altius Commercial |
$23.19
|
| Rate for Payer: Beech Street Commercial |
$23.68
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.44
|
| Rate for Payer: Cash Price |
$16.91
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.44
|
| Rate for Payer: Cigna of WY Commercial |
$23.68
|
| Rate for Payer: Entrust Commercial |
$22.95
|
| Rate for Payer: First Choice Health Commercial |
$22.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$22.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.77
|
| Rate for Payer: HealthUtah PPO |
$24.16
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.44
|
| Rate for Payer: Multiplan Medicare/VA |
$13.08
|
| Rate for Payer: One Health Plan of WY PPO |
$23.68
|
| Rate for Payer: PacificSource Commercial |
$21.74
|
| Rate for Payer: PHCS PPO |
$23.68
|
| Rate for Payer: Three Rivers PPO |
$18.12
|
| Rate for Payer: TriWest Veterans Administration |
$13.77
|
| Rate for Payer: United Healthcare Commercial |
$23.07
|
| Rate for Payer: United Healthcare Medicare |
$13.77
|
| Rate for Payer: WINHealth Partners Commercial |
$23.68
|
| Rate for Payer: Wise Provider Network Commercial |
$22.95
|
|
|
CHEMO SHEILD 28MM MV0528
|
Facility
|
IP
|
$24.29
|
|
| Hospital Charge Code |
2050090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: United Healthcare Commercial |
$23.20
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.80
|
| Rate for Payer: Aetna of WY Medicare |
$15.55
|
| Rate for Payer: Altius Commercial |
$23.32
|
| Rate for Payer: Beech Street Commercial |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.56
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.56
|
| Rate for Payer: Cigna of WY Commercial |
$23.80
|
| Rate for Payer: Entrust Commercial |
$23.08
|
| Rate for Payer: First Choice Health Commercial |
$23.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.82
|
| Rate for Payer: HealthUtah PPO |
$24.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.56
|
| Rate for Payer: Multiplan Medicare/VA |
$14.08
|
| Rate for Payer: One Health Plan of WY PPO |
$23.80
|
| Rate for Payer: PacificSource Commercial |
$21.86
|
| Rate for Payer: PHCS PPO |
$23.80
|
| Rate for Payer: Three Rivers PPO |
$18.22
|
| Rate for Payer: TriWest Veterans Administration |
$14.82
|
| Rate for Payer: United Healthcare Medicare |
$14.82
|
| Rate for Payer: WINHealth Partners Commercial |
$23.08
|
| Rate for Payer: Wise Provider Network Commercial |
$23.08
|
|
|
CHEMO SHEILD 28MM MV0528
|
Facility
|
OP
|
$24.29
|
|
| Hospital Charge Code |
2050090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$24.29 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$23.80
|
| Rate for Payer: Aetna of WY Medicare |
$16.03
|
| Rate for Payer: Altius Commercial |
$23.32
|
| Rate for Payer: Beech Street Commercial |
$23.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$23.56
|
| Rate for Payer: Cash Price |
$17.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$23.56
|
| Rate for Payer: Cigna of WY Commercial |
$23.80
|
| Rate for Payer: Entrust Commercial |
$23.08
|
| Rate for Payer: First Choice Health Commercial |
$23.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$23.08
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.85
|
| Rate for Payer: HealthUtah PPO |
$24.29
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$23.56
|
| Rate for Payer: Multiplan Medicare/VA |
$13.15
|
| Rate for Payer: One Health Plan of WY PPO |
$23.80
|
| Rate for Payer: PacificSource Commercial |
$21.86
|
| Rate for Payer: PHCS PPO |
$23.80
|
| Rate for Payer: Three Rivers PPO |
$18.22
|
| Rate for Payer: TriWest Veterans Administration |
$13.85
|
| Rate for Payer: United Healthcare Commercial |
$23.20
|
| Rate for Payer: United Healthcare Medicare |
$13.85
|
| Rate for Payer: WINHealth Partners Commercial |
$23.80
|
| Rate for Payer: Wise Provider Network Commercial |
$23.08
|
|
|
CHEMO TEXIUM LUER FEM CAP
|
Facility
|
OP
|
$6.56
|
|
| Hospital Charge Code |
2050094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Aetna of WY Medicare |
$4.33
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.74
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$3.55
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$3.74
|
| Rate for Payer: WINHealth Partners Commercial |
$6.43
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
CHEMO TEXIUM LUER FEM CAP
|
Facility
|
IP
|
$6.56
|
|
| Hospital Charge Code |
2050094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6.43
|
| Rate for Payer: Aetna of WY Medicare |
$4.20
|
| Rate for Payer: Altius Commercial |
$6.30
|
| Rate for Payer: Beech Street Commercial |
$6.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$6.36
|
| Rate for Payer: Cash Price |
$4.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$6.36
|
| Rate for Payer: Cigna of WY Commercial |
$6.43
|
| Rate for Payer: Entrust Commercial |
$6.23
|
| Rate for Payer: First Choice Health Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6.23
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.00
|
| Rate for Payer: HealthUtah PPO |
$6.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6.36
|
| Rate for Payer: Multiplan Medicare/VA |
$3.80
|
| Rate for Payer: One Health Plan of WY PPO |
$6.43
|
| Rate for Payer: PacificSource Commercial |
$5.90
|
| Rate for Payer: PHCS PPO |
$6.43
|
| Rate for Payer: Three Rivers PPO |
$4.92
|
| Rate for Payer: TriWest Veterans Administration |
$4.00
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
| Rate for Payer: WINHealth Partners Commercial |
$6.23
|
| Rate for Payer: Wise Provider Network Commercial |
$6.23
|
|
|
CHEMO VENTED VIAL 20MM MV0420
|
Facility
|
OP
|
$12.30
|
|
| Hospital Charge Code |
2050093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$12.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.05
|
| Rate for Payer: Aetna of WY Medicare |
$8.12
|
| Rate for Payer: Altius Commercial |
$11.81
|
| Rate for Payer: Beech Street Commercial |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.93
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.93
|
| Rate for Payer: Cigna of WY Commercial |
$12.05
|
| Rate for Payer: Entrust Commercial |
$11.68
|
| Rate for Payer: First Choice Health Commercial |
$11.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.01
|
| Rate for Payer: HealthUtah PPO |
$12.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.93
|
| Rate for Payer: Multiplan Medicare/VA |
$6.66
|
| Rate for Payer: One Health Plan of WY PPO |
$12.05
|
| Rate for Payer: PacificSource Commercial |
$11.07
|
| Rate for Payer: PHCS PPO |
$12.05
|
| Rate for Payer: Three Rivers PPO |
$9.22
|
| Rate for Payer: TriWest Veterans Administration |
$7.01
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$7.01
|
| Rate for Payer: WINHealth Partners Commercial |
$12.05
|
| Rate for Payer: Wise Provider Network Commercial |
$11.68
|
|
|
CHEMO VENTED VIAL 20MM MV0420
|
Facility
|
IP
|
$12.30
|
|
| Hospital Charge Code |
2050093
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.13 |
| Max. Negotiated Rate |
$12.30 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.05
|
| Rate for Payer: Aetna of WY Medicare |
$7.87
|
| Rate for Payer: Altius Commercial |
$11.81
|
| Rate for Payer: Beech Street Commercial |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$11.93
|
| Rate for Payer: Cash Price |
$8.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.93
|
| Rate for Payer: Cigna of WY Commercial |
$12.05
|
| Rate for Payer: Entrust Commercial |
$11.68
|
| Rate for Payer: First Choice Health Commercial |
$11.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.50
|
| Rate for Payer: HealthUtah PPO |
$12.30
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.93
|
| Rate for Payer: Multiplan Medicare/VA |
$7.13
|
| Rate for Payer: One Health Plan of WY PPO |
$12.05
|
| Rate for Payer: PacificSource Commercial |
$11.07
|
| Rate for Payer: PHCS PPO |
$12.05
|
| Rate for Payer: Three Rivers PPO |
$9.22
|
| Rate for Payer: TriWest Veterans Administration |
$7.50
|
| Rate for Payer: United Healthcare Commercial |
$11.75
|
| Rate for Payer: United Healthcare Medicare |
$7.50
|
| Rate for Payer: WINHealth Partners Commercial |
$11.68
|
| Rate for Payer: Wise Provider Network Commercial |
$11.68
|
|
|
CHEST TUBE 10 F WTROC
|
Facility
|
OP
|
$61.75
|
|
| Hospital Charge Code |
2600051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.52
|
| Rate for Payer: Aetna of WY Medicare |
$40.76
|
| Rate for Payer: Altius Commercial |
$59.28
|
| Rate for Payer: Beech Street Commercial |
$60.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.90
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.90
|
| Rate for Payer: Cigna of WY Commercial |
$60.52
|
| Rate for Payer: Entrust Commercial |
$58.66
|
| Rate for Payer: First Choice Health Commercial |
$58.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.20
|
| Rate for Payer: HealthUtah PPO |
$61.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.90
|
| Rate for Payer: Multiplan Medicare/VA |
$33.44
|
| Rate for Payer: One Health Plan of WY PPO |
$60.52
|
| Rate for Payer: PacificSource Commercial |
$55.58
|
| Rate for Payer: PHCS PPO |
$60.52
|
| Rate for Payer: Three Rivers PPO |
$46.31
|
| Rate for Payer: TriWest Veterans Administration |
$35.20
|
| Rate for Payer: United Healthcare Commercial |
$58.97
|
| Rate for Payer: United Healthcare Medicare |
$35.20
|
| Rate for Payer: WINHealth Partners Commercial |
$60.52
|
| Rate for Payer: Wise Provider Network Commercial |
$58.66
|
|
|
CHEST TUBE 10 F WTROC
|
Facility
|
IP
|
$61.75
|
|
| Hospital Charge Code |
2600051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$60.52
|
| Rate for Payer: Aetna of WY Medicare |
$39.52
|
| Rate for Payer: Altius Commercial |
$59.28
|
| Rate for Payer: Beech Street Commercial |
$60.52
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$59.90
|
| Rate for Payer: Cash Price |
$43.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.90
|
| Rate for Payer: Cigna of WY Commercial |
$60.52
|
| Rate for Payer: Entrust Commercial |
$58.66
|
| Rate for Payer: First Choice Health Commercial |
$58.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$58.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.67
|
| Rate for Payer: HealthUtah PPO |
$61.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.90
|
| Rate for Payer: Multiplan Medicare/VA |
$35.78
|
| Rate for Payer: One Health Plan of WY PPO |
$60.52
|
| Rate for Payer: PacificSource Commercial |
$55.58
|
| Rate for Payer: PHCS PPO |
$60.52
|
| Rate for Payer: Three Rivers PPO |
$46.31
|
| Rate for Payer: TriWest Veterans Administration |
$37.67
|
| Rate for Payer: United Healthcare Commercial |
$58.97
|
| Rate for Payer: United Healthcare Medicare |
$37.67
|
| Rate for Payer: WINHealth Partners Commercial |
$58.66
|
| Rate for Payer: Wise Provider Network Commercial |
$58.66
|
|
