|
ADRENALIN EPINEPHRINE INJECT
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS J0171
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$52.92
|
| Rate for Payer: Aetna of WY Medicare |
$0.81
|
| Rate for Payer: Beech Street Commercial |
$51.30
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$52.38
|
| Rate for Payer: Cigna of WY Commercial |
$52.92
|
| Rate for Payer: First Choice Health Commercial |
$48.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$51.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.81
|
| Rate for Payer: HealthUtah PPO |
$54.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$52.38
|
| Rate for Payer: Multiplan Medicare/VA |
$0.69
|
| Rate for Payer: One Health Plan of WY PPO |
$52.92
|
| Rate for Payer: PacificSource Commercial |
$48.60
|
| Rate for Payer: PHCS PPO |
$51.30
|
| Rate for Payer: Three Rivers PPO |
$40.50
|
| Rate for Payer: TriWest Veterans Administration |
$0.81
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: WINHealth Partners Commercial |
$51.30
|
|
|
ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 99498
|
| Min. Negotiated Rate |
$53.25 |
| Max. Negotiated Rate |
$71.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$69.58
|
| Rate for Payer: Beech Street Commercial |
$67.45
|
| Rate for Payer: Cash Price |
$49.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$68.87
|
| Rate for Payer: Cigna of WY Commercial |
$69.58
|
| Rate for Payer: First Choice Health Commercial |
$63.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$67.45
|
| Rate for Payer: HealthUtah PPO |
$71.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$68.87
|
| Rate for Payer: One Health Plan of WY PPO |
$69.58
|
| Rate for Payer: PacificSource Commercial |
$63.90
|
| Rate for Payer: PHCS PPO |
$67.45
|
| Rate for Payer: Three Rivers PPO |
$53.25
|
| Rate for Payer: United Healthcare Commercial |
$67.45
|
| Rate for Payer: WINHealth Partners Commercial |
$67.45
|
|
|
ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 99497
|
| Min. Negotiated Rate |
$61.62 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$113.68
|
| Rate for Payer: Aetna of WY Medicare |
$72.49
|
| Rate for Payer: Beech Street Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: Cash Price |
$81.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$112.52
|
| Rate for Payer: Cigna of WY Commercial |
$113.68
|
| Rate for Payer: First Choice Health Commercial |
$104.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$110.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$72.49
|
| Rate for Payer: HealthUtah PPO |
$116.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$112.52
|
| Rate for Payer: Multiplan Medicare/VA |
$61.62
|
| Rate for Payer: One Health Plan of WY PPO |
$113.68
|
| Rate for Payer: PacificSource Commercial |
$104.40
|
| Rate for Payer: PHCS PPO |
$110.20
|
| Rate for Payer: Three Rivers PPO |
$87.00
|
| Rate for Payer: TriWest Veterans Administration |
$72.49
|
| Rate for Payer: United Healthcare Commercial |
$110.20
|
| Rate for Payer: WINHealth Partners Commercial |
$110.20
|
|
|
AEROBIKA POSITIVE EXPIRATORY
|
Facility
|
OP
|
$159.50
|
|
| Hospital Charge Code |
2100105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.37 |
| Max. Negotiated Rate |
$159.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.31
|
| Rate for Payer: Aetna of WY Medicare |
$105.27
|
| Rate for Payer: Altius Commercial |
$153.12
|
| Rate for Payer: Beech Street Commercial |
$156.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.72
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.72
|
| Rate for Payer: Cigna of WY Commercial |
$156.31
|
| Rate for Payer: Entrust Commercial |
$151.52
|
| Rate for Payer: First Choice Health Commercial |
$151.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$90.92
|
| Rate for Payer: HealthUtah PPO |
$159.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.72
|
| Rate for Payer: Multiplan Medicare/VA |
$86.37
|
| Rate for Payer: One Health Plan of WY PPO |
$156.31
|
| Rate for Payer: PacificSource Commercial |
$143.55
|
| Rate for Payer: PHCS PPO |
$156.31
|
| Rate for Payer: Three Rivers PPO |
$119.62
|
| Rate for Payer: TriWest Veterans Administration |
$90.92
|
| Rate for Payer: United Healthcare Commercial |
$152.32
|
| Rate for Payer: United Healthcare Medicare |
$90.92
|
| Rate for Payer: WINHealth Partners Commercial |
$156.31
|
| Rate for Payer: Wise Provider Network Commercial |
$151.52
|
|
|
AEROBIKA POSITIVE EXPIRATORY
|
Facility
|
IP
|
$159.50
|
|
| Hospital Charge Code |
2100105
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$92.43 |
| Max. Negotiated Rate |
$159.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$156.31
|
| Rate for Payer: Aetna of WY Medicare |
$102.08
|
| Rate for Payer: Altius Commercial |
$153.12
|
| Rate for Payer: Beech Street Commercial |
$156.31
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$154.72
|
| Rate for Payer: Cash Price |
$111.65
|
| Rate for Payer: ChoiceCare Network Commercial |
$154.72
|
| Rate for Payer: Cigna of WY Commercial |
$156.31
|
| Rate for Payer: Entrust Commercial |
$151.52
|
| Rate for Payer: First Choice Health Commercial |
$151.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$151.52
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$97.30
|
| Rate for Payer: HealthUtah PPO |
$159.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$154.72
|
| Rate for Payer: Multiplan Medicare/VA |
$92.43
|
| Rate for Payer: One Health Plan of WY PPO |
$156.31
|
| Rate for Payer: PacificSource Commercial |
$143.55
|
| Rate for Payer: PHCS PPO |
$156.31
|
| Rate for Payer: Three Rivers PPO |
$119.62
|
| Rate for Payer: TriWest Veterans Administration |
$97.30
|
| Rate for Payer: United Healthcare Commercial |
$152.32
|
| Rate for Payer: United Healthcare Medicare |
$97.30
|
| Rate for Payer: WINHealth Partners Commercial |
$151.52
|
| Rate for Payer: Wise Provider Network Commercial |
$151.52
|
|
|
AEROECLIPSE BREATH ACTUATE NEB
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
2100014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.23
|
| Rate for Payer: Aetna of WY Medicare |
$10.93
|
| Rate for Payer: Altius Commercial |
$15.90
|
| Rate for Payer: Beech Street Commercial |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.06
|
| Rate for Payer: Cigna of WY Commercial |
$16.23
|
| Rate for Payer: Entrust Commercial |
$15.73
|
| Rate for Payer: First Choice Health Commercial |
$15.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.44
|
| Rate for Payer: HealthUtah PPO |
$16.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.06
|
| Rate for Payer: Multiplan Medicare/VA |
$8.97
|
| Rate for Payer: One Health Plan of WY PPO |
$16.23
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.23
|
| Rate for Payer: Three Rivers PPO |
$12.42
|
| Rate for Payer: TriWest Veterans Administration |
$9.44
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$9.44
|
| Rate for Payer: WINHealth Partners Commercial |
$16.23
|
| Rate for Payer: Wise Provider Network Commercial |
$15.73
|
|
|
AEROECLIPSE BREATH ACTUATE NEB
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
2100014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$16.23
|
| Rate for Payer: Aetna of WY Medicare |
$10.60
|
| Rate for Payer: Altius Commercial |
$15.90
|
| Rate for Payer: Beech Street Commercial |
$16.23
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.06
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: ChoiceCare Network Commercial |
$16.06
|
| Rate for Payer: Cigna of WY Commercial |
$16.23
|
| Rate for Payer: Entrust Commercial |
$15.73
|
| Rate for Payer: First Choice Health Commercial |
$15.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$15.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.10
|
| Rate for Payer: HealthUtah PPO |
$16.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$16.06
|
| Rate for Payer: Multiplan Medicare/VA |
$9.60
|
| Rate for Payer: One Health Plan of WY PPO |
$16.23
|
| Rate for Payer: PacificSource Commercial |
$14.90
|
| Rate for Payer: PHCS PPO |
$16.23
|
| Rate for Payer: Three Rivers PPO |
$12.42
|
| Rate for Payer: TriWest Veterans Administration |
$10.10
|
| Rate for Payer: United Healthcare Commercial |
$15.81
|
| Rate for Payer: United Healthcare Medicare |
$10.10
|
| Rate for Payer: WINHealth Partners Commercial |
$15.73
|
| Rate for Payer: Wise Provider Network Commercial |
$15.73
|
|
|
AEROECLIPSE OMBRA COMPRESSOR
|
Facility
|
OP
|
$314.96
|
|
| Hospital Charge Code |
2100013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.55 |
| Max. Negotiated Rate |
$314.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.66
|
| Rate for Payer: Aetna of WY Medicare |
$207.87
|
| Rate for Payer: Altius Commercial |
$302.36
|
| Rate for Payer: Beech Street Commercial |
$308.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$305.51
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.51
|
| Rate for Payer: Cigna of WY Commercial |
$308.66
|
| Rate for Payer: Entrust Commercial |
$299.21
|
| Rate for Payer: First Choice Health Commercial |
$299.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$179.53
|
| Rate for Payer: HealthUtah PPO |
$314.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.51
|
| Rate for Payer: Multiplan Medicare/VA |
$170.55
|
| Rate for Payer: One Health Plan of WY PPO |
$308.66
|
| Rate for Payer: PacificSource Commercial |
$283.46
|
| Rate for Payer: PHCS PPO |
$308.66
|
| Rate for Payer: Three Rivers PPO |
$236.22
|
| Rate for Payer: TriWest Veterans Administration |
$179.53
|
| Rate for Payer: United Healthcare Commercial |
$300.79
|
| Rate for Payer: United Healthcare Medicare |
$179.53
|
| Rate for Payer: WINHealth Partners Commercial |
$308.66
|
| Rate for Payer: Wise Provider Network Commercial |
$299.21
|
|
|
AEROECLIPSE OMBRA COMPRESSOR
|
Facility
|
IP
|
$314.96
|
|
| Hospital Charge Code |
2100013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.52 |
| Max. Negotiated Rate |
$314.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$308.66
|
| Rate for Payer: Aetna of WY Medicare |
$201.57
|
| Rate for Payer: Altius Commercial |
$302.36
|
| Rate for Payer: Beech Street Commercial |
$308.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$305.51
|
| Rate for Payer: Cash Price |
$220.48
|
| Rate for Payer: ChoiceCare Network Commercial |
$305.51
|
| Rate for Payer: Cigna of WY Commercial |
$308.66
|
| Rate for Payer: Entrust Commercial |
$299.21
|
| Rate for Payer: First Choice Health Commercial |
$299.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$299.21
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$192.13
|
| Rate for Payer: HealthUtah PPO |
$314.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$305.51
|
| Rate for Payer: Multiplan Medicare/VA |
$182.52
|
| Rate for Payer: One Health Plan of WY PPO |
$308.66
|
| Rate for Payer: PacificSource Commercial |
$283.46
|
| Rate for Payer: PHCS PPO |
$308.66
|
| Rate for Payer: Three Rivers PPO |
$236.22
|
| Rate for Payer: TriWest Veterans Administration |
$192.13
|
| Rate for Payer: United Healthcare Commercial |
$300.79
|
| Rate for Payer: United Healthcare Medicare |
$192.13
|
| Rate for Payer: WINHealth Partners Commercial |
$299.21
|
| Rate for Payer: Wise Provider Network Commercial |
$299.21
|
|
|
AEROSOL MASK PED 1080
|
Facility
|
IP
|
$1.47
|
|
| Hospital Charge Code |
2100069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Aetna of WY Medicare |
$0.94
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.90
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.85
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$0.90
|
| Rate for Payer: WINHealth Partners Commercial |
$1.40
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
AEROSOL MASK PED 1080
|
Facility
|
OP
|
$1.47
|
|
| Hospital Charge Code |
2100069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.44
|
| Rate for Payer: Aetna of WY Medicare |
$0.97
|
| Rate for Payer: Altius Commercial |
$1.41
|
| Rate for Payer: Beech Street Commercial |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.43
|
| Rate for Payer: Cigna of WY Commercial |
$1.44
|
| Rate for Payer: Entrust Commercial |
$1.40
|
| Rate for Payer: First Choice Health Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.84
|
| Rate for Payer: HealthUtah PPO |
$1.47
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.43
|
| Rate for Payer: Multiplan Medicare/VA |
$0.80
|
| Rate for Payer: One Health Plan of WY PPO |
$1.44
|
| Rate for Payer: PacificSource Commercial |
$1.32
|
| Rate for Payer: PHCS PPO |
$1.44
|
| Rate for Payer: Three Rivers PPO |
$1.10
|
| Rate for Payer: TriWest Veterans Administration |
$0.84
|
| Rate for Payer: United Healthcare Commercial |
$1.40
|
| Rate for Payer: United Healthcare Medicare |
$0.84
|
| Rate for Payer: WINHealth Partners Commercial |
$1.44
|
| Rate for Payer: Wise Provider Network Commercial |
$1.40
|
|
|
AFO ANKLE GAUNTLET PRE OTS
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS L1902
|
| Min. Negotiated Rate |
$72.75 |
| Max. Negotiated Rate |
$97.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$95.06
|
| Rate for Payer: Beech Street Commercial |
$92.15
|
| Rate for Payer: Cash Price |
$67.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$94.09
|
| Rate for Payer: Cigna of WY Commercial |
$95.06
|
| Rate for Payer: First Choice Health Commercial |
$87.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$92.15
|
| Rate for Payer: HealthUtah PPO |
$97.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$94.09
|
| Rate for Payer: One Health Plan of WY PPO |
$95.06
|
| Rate for Payer: PacificSource Commercial |
$87.30
|
| Rate for Payer: PHCS PPO |
$92.15
|
| Rate for Payer: Three Rivers PPO |
$72.75
|
| Rate for Payer: United Healthcare Commercial |
$92.15
|
| Rate for Payer: WINHealth Partners Commercial |
$92.15
|
|
|
AFO MULTILIG ANK SUP PRE OTS
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
HCPCS L1906
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$93.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$91.14
|
| Rate for Payer: Beech Street Commercial |
$88.35
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$90.21
|
| Rate for Payer: Cigna of WY Commercial |
$91.14
|
| Rate for Payer: First Choice Health Commercial |
$83.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.35
|
| Rate for Payer: HealthUtah PPO |
$93.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$90.21
|
| Rate for Payer: One Health Plan of WY PPO |
$91.14
|
| Rate for Payer: PacificSource Commercial |
$83.70
|
| Rate for Payer: PHCS PPO |
$88.35
|
| Rate for Payer: Three Rivers PPO |
$69.75
|
| Rate for Payer: United Healthcare Commercial |
$88.35
|
| Rate for Payer: WINHealth Partners Commercial |
$88.35
|
|
|
AFO PLASTIC
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS L1930
|
| Min. Negotiated Rate |
$197.25 |
| Max. Negotiated Rate |
$263.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$257.74
|
| Rate for Payer: Beech Street Commercial |
$249.85
|
| Rate for Payer: Cash Price |
$184.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$255.11
|
| Rate for Payer: Cigna of WY Commercial |
$257.74
|
| Rate for Payer: First Choice Health Commercial |
$236.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$249.85
|
| Rate for Payer: HealthUtah PPO |
$263.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$255.11
|
| Rate for Payer: One Health Plan of WY PPO |
$257.74
|
| Rate for Payer: PacificSource Commercial |
$236.70
|
| Rate for Payer: PHCS PPO |
$249.85
|
| Rate for Payer: Three Rivers PPO |
$197.25
|
| Rate for Payer: United Healthcare Commercial |
$249.85
|
| Rate for Payer: WINHealth Partners Commercial |
$249.85
|
|
|
AFO TIBIAL FRACTURE SOFT
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS L2112
|
| Min. Negotiated Rate |
$92.25 |
| Max. Negotiated Rate |
$123.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$120.54
|
| Rate for Payer: Beech Street Commercial |
$116.85
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$119.31
|
| Rate for Payer: Cigna of WY Commercial |
$120.54
|
| Rate for Payer: First Choice Health Commercial |
$110.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$116.85
|
| Rate for Payer: HealthUtah PPO |
$123.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$119.31
|
| Rate for Payer: One Health Plan of WY PPO |
$120.54
|
| Rate for Payer: PacificSource Commercial |
$110.70
|
| Rate for Payer: PHCS PPO |
$116.85
|
| Rate for Payer: Three Rivers PPO |
$92.25
|
| Rate for Payer: United Healthcare Commercial |
$116.85
|
| Rate for Payer: WINHealth Partners Commercial |
$116.85
|
|
|
AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 90694
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$77.36
|
| Rate for Payer: Beech Street Commercial |
$84.55
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: Cash Price |
$62.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$86.33
|
| Rate for Payer: Cigna of WY Commercial |
$87.22
|
| Rate for Payer: First Choice Health Commercial |
$80.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$84.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.36
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$65.76
|
| Rate for Payer: One Health Plan of WY PPO |
$87.22
|
| Rate for Payer: PacificSource Commercial |
$80.10
|
| Rate for Payer: PHCS PPO |
$84.55
|
| Rate for Payer: Three Rivers PPO |
$66.75
|
| Rate for Payer: TriWest Veterans Administration |
$20.00
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: WINHealth Partners Commercial |
$89.00
|
|
|
AIR CHARGE DUAL SENSOR CATHETER
|
Facility
|
IP
|
$197.75
|
|
| Hospital Charge Code |
3004070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.60 |
| Max. Negotiated Rate |
$197.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.80
|
| Rate for Payer: Aetna of WY Medicare |
$126.56
|
| Rate for Payer: Altius Commercial |
$189.84
|
| Rate for Payer: Beech Street Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.82
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.82
|
| Rate for Payer: Cigna of WY Commercial |
$193.80
|
| Rate for Payer: Entrust Commercial |
$187.86
|
| Rate for Payer: First Choice Health Commercial |
$187.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$120.63
|
| Rate for Payer: HealthUtah PPO |
$197.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.82
|
| Rate for Payer: Multiplan Medicare/VA |
$114.60
|
| Rate for Payer: One Health Plan of WY PPO |
$193.80
|
| Rate for Payer: PacificSource Commercial |
$177.98
|
| Rate for Payer: PHCS PPO |
$193.80
|
| Rate for Payer: Three Rivers PPO |
$148.31
|
| Rate for Payer: TriWest Veterans Administration |
$120.63
|
| Rate for Payer: United Healthcare Commercial |
$188.85
|
| Rate for Payer: United Healthcare Medicare |
$120.63
|
| Rate for Payer: WINHealth Partners Commercial |
$187.86
|
| Rate for Payer: Wise Provider Network Commercial |
$187.86
|
|
|
AIR CHARGE DUAL SENSOR CATHETER
|
Facility
|
OP
|
$197.75
|
|
| Hospital Charge Code |
3004070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.08 |
| Max. Negotiated Rate |
$197.75 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$193.80
|
| Rate for Payer: Aetna of WY Medicare |
$130.52
|
| Rate for Payer: Altius Commercial |
$189.84
|
| Rate for Payer: Beech Street Commercial |
$193.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$191.82
|
| Rate for Payer: Cash Price |
$138.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$191.82
|
| Rate for Payer: Cigna of WY Commercial |
$193.80
|
| Rate for Payer: Entrust Commercial |
$187.86
|
| Rate for Payer: First Choice Health Commercial |
$187.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$187.86
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$112.72
|
| Rate for Payer: HealthUtah PPO |
$197.75
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$191.82
|
| Rate for Payer: Multiplan Medicare/VA |
$107.08
|
| Rate for Payer: One Health Plan of WY PPO |
$193.80
|
| Rate for Payer: PacificSource Commercial |
$177.98
|
| Rate for Payer: PHCS PPO |
$193.80
|
| Rate for Payer: Three Rivers PPO |
$148.31
|
| Rate for Payer: TriWest Veterans Administration |
$112.72
|
| Rate for Payer: United Healthcare Commercial |
$188.85
|
| Rate for Payer: United Healthcare Medicare |
$112.72
|
| Rate for Payer: WINHealth Partners Commercial |
$193.80
|
| Rate for Payer: Wise Provider Network Commercial |
$187.86
|
|
|
AIR CHARGE SINGLE SENSOR CATHETER
|
Facility
|
IP
|
$133.00
|
|
| Hospital Charge Code |
3004071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.07 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$85.12
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$81.13
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$77.07
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$81.13
|
| Rate for Payer: United Healthcare Medicare |
$81.13
|
| Rate for Payer: WINHealth Partners Commercial |
$126.35
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
AIR CHARGE SINGLE SENSOR CATHETER
|
Facility
|
OP
|
$133.00
|
|
| Hospital Charge Code |
3004071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.02 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$130.34
|
| Rate for Payer: Aetna of WY Medicare |
$87.78
|
| Rate for Payer: Altius Commercial |
$127.68
|
| Rate for Payer: Beech Street Commercial |
$130.34
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.01
|
| Rate for Payer: Cash Price |
$93.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$129.01
|
| Rate for Payer: Cigna of WY Commercial |
$130.34
|
| Rate for Payer: Entrust Commercial |
$126.35
|
| Rate for Payer: First Choice Health Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$126.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$75.81
|
| Rate for Payer: HealthUtah PPO |
$133.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$129.01
|
| Rate for Payer: Multiplan Medicare/VA |
$72.02
|
| Rate for Payer: One Health Plan of WY PPO |
$130.34
|
| Rate for Payer: PacificSource Commercial |
$119.70
|
| Rate for Payer: PHCS PPO |
$130.34
|
| Rate for Payer: Three Rivers PPO |
$99.75
|
| Rate for Payer: TriWest Veterans Administration |
$75.81
|
| Rate for Payer: United Healthcare Commercial |
$127.02
|
| Rate for Payer: United Healthcare Medicare |
$75.81
|
| Rate for Payer: WINHealth Partners Commercial |
$130.34
|
| Rate for Payer: Wise Provider Network Commercial |
$126.35
|
|
|
AIRFIT F10 MASK LARGE
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
6750069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.73
|
| Rate for Payer: Aetna of WY Medicare |
$24.64
|
| Rate for Payer: Altius Commercial |
$36.96
|
| Rate for Payer: Beech Street Commercial |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.34
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.34
|
| Rate for Payer: Cigna of WY Commercial |
$37.73
|
| Rate for Payer: Entrust Commercial |
$36.58
|
| Rate for Payer: First Choice Health Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.48
|
| Rate for Payer: HealthUtah PPO |
$38.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.34
|
| Rate for Payer: Multiplan Medicare/VA |
$22.31
|
| Rate for Payer: One Health Plan of WY PPO |
$37.73
|
| Rate for Payer: PacificSource Commercial |
$34.65
|
| Rate for Payer: PHCS PPO |
$37.73
|
| Rate for Payer: Three Rivers PPO |
$28.88
|
| Rate for Payer: TriWest Veterans Administration |
$23.48
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WINHealth Partners Commercial |
$36.58
|
| Rate for Payer: Wise Provider Network Commercial |
$36.58
|
|
|
AIRFIT F10 MASK LARGE
|
Facility
|
OP
|
$38.50
|
|
| Hospital Charge Code |
6750069
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.73
|
| Rate for Payer: Aetna of WY Medicare |
$25.41
|
| Rate for Payer: Altius Commercial |
$36.96
|
| Rate for Payer: Beech Street Commercial |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.34
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.34
|
| Rate for Payer: Cigna of WY Commercial |
$37.73
|
| Rate for Payer: Entrust Commercial |
$36.58
|
| Rate for Payer: First Choice Health Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.94
|
| Rate for Payer: HealthUtah PPO |
$38.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.34
|
| Rate for Payer: Multiplan Medicare/VA |
$20.85
|
| Rate for Payer: One Health Plan of WY PPO |
$37.73
|
| Rate for Payer: PacificSource Commercial |
$34.65
|
| Rate for Payer: PHCS PPO |
$37.73
|
| Rate for Payer: Three Rivers PPO |
$28.88
|
| Rate for Payer: TriWest Veterans Administration |
$21.94
|
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: United Healthcare Medicare |
$21.94
|
| Rate for Payer: WINHealth Partners Commercial |
$37.73
|
| Rate for Payer: Wise Provider Network Commercial |
$36.58
|
|
|
AIRFIT F10 MASK MEDIUM
|
Facility
|
OP
|
$38.50
|
|
| Hospital Charge Code |
6750068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$20.85 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.73
|
| Rate for Payer: Aetna of WY Medicare |
$25.41
|
| Rate for Payer: Altius Commercial |
$36.96
|
| Rate for Payer: Beech Street Commercial |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.34
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.34
|
| Rate for Payer: Cigna of WY Commercial |
$37.73
|
| Rate for Payer: Entrust Commercial |
$36.58
|
| Rate for Payer: First Choice Health Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$21.94
|
| Rate for Payer: HealthUtah PPO |
$38.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.34
|
| Rate for Payer: Multiplan Medicare/VA |
$20.85
|
| Rate for Payer: One Health Plan of WY PPO |
$37.73
|
| Rate for Payer: PacificSource Commercial |
$34.65
|
| Rate for Payer: PHCS PPO |
$37.73
|
| Rate for Payer: Three Rivers PPO |
$28.88
|
| Rate for Payer: TriWest Veterans Administration |
$21.94
|
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: United Healthcare Medicare |
$21.94
|
| Rate for Payer: WINHealth Partners Commercial |
$37.73
|
| Rate for Payer: Wise Provider Network Commercial |
$36.58
|
|
|
AIRFIT F10 MASK MEDIUM
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
6750068
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.73
|
| Rate for Payer: Aetna of WY Medicare |
$24.64
|
| Rate for Payer: Altius Commercial |
$36.96
|
| Rate for Payer: Beech Street Commercial |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.34
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.34
|
| Rate for Payer: Cigna of WY Commercial |
$37.73
|
| Rate for Payer: Entrust Commercial |
$36.58
|
| Rate for Payer: First Choice Health Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.48
|
| Rate for Payer: HealthUtah PPO |
$38.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.34
|
| Rate for Payer: Multiplan Medicare/VA |
$22.31
|
| Rate for Payer: One Health Plan of WY PPO |
$37.73
|
| Rate for Payer: PacificSource Commercial |
$34.65
|
| Rate for Payer: PHCS PPO |
$37.73
|
| Rate for Payer: Three Rivers PPO |
$28.88
|
| Rate for Payer: TriWest Veterans Administration |
$23.48
|
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WINHealth Partners Commercial |
$36.58
|
| Rate for Payer: Wise Provider Network Commercial |
$36.58
|
|
|
AIRFIT F10 MASK SMALL
|
Facility
|
IP
|
$38.50
|
|
| Hospital Charge Code |
6750067
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$22.31 |
| Max. Negotiated Rate |
$38.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$37.73
|
| Rate for Payer: Aetna of WY Medicare |
$24.64
|
| Rate for Payer: Altius Commercial |
$36.96
|
| Rate for Payer: Beech Street Commercial |
$37.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$37.34
|
| Rate for Payer: Cash Price |
$26.95
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.34
|
| Rate for Payer: Cigna of WY Commercial |
$37.73
|
| Rate for Payer: Entrust Commercial |
$36.58
|
| Rate for Payer: First Choice Health Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$36.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$23.48
|
| Rate for Payer: HealthUtah PPO |
$38.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.34
|
| Rate for Payer: Multiplan Medicare/VA |
$22.31
|
| Rate for Payer: One Health Plan of WY PPO |
$37.73
|
| Rate for Payer: PacificSource Commercial |
$34.65
|
| Rate for Payer: PHCS PPO |
$37.73
|
| Rate for Payer: Three Rivers PPO |
$28.88
|
| Rate for Payer: TriWest Veterans Administration |
$23.48
|
| Rate for Payer: United Healthcare Commercial |
$36.77
|
| Rate for Payer: United Healthcare Medicare |
$23.48
|
| Rate for Payer: WINHealth Partners Commercial |
$36.58
|
| Rate for Payer: Wise Provider Network Commercial |
$36.58
|
|
