|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
NDC 6068738911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$28.93
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.57
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$26.19
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$27.57
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$27.57
|
| Rate for Payer: WINHealth Partners Commercial |
$42.94
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
NDC 6068738921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$28.93
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.57
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$26.19
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$27.57
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$27.57
|
| Rate for Payer: WINHealth Partners Commercial |
$42.94
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$45.20
|
|
|
Service Code
|
NDC 6068738911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$29.83
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.76
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$24.48
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$25.76
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$25.76
|
| Rate for Payer: WINHealth Partners Commercial |
$44.30
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$45.20
|
|
|
Service Code
|
NDC 4229205401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$29.83
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.76
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$24.48
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$25.76
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$25.76
|
| Rate for Payer: WINHealth Partners Commercial |
$44.30
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
OP
|
$45.20
|
|
|
Service Code
|
NDC 6068738921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.48 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$29.83
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.76
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$24.48
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$25.76
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$25.76
|
| Rate for Payer: WINHealth Partners Commercial |
$44.30
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCHICINE 0.6 MG TABLET [17975]
|
Facility
|
IP
|
$45.20
|
|
|
Service Code
|
NDC 4229205401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.19 |
| Max. Negotiated Rate |
$45.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.30
|
| Rate for Payer: Aetna of WY Medicare |
$28.93
|
| Rate for Payer: Altius Commercial |
$43.39
|
| Rate for Payer: Beech Street Commercial |
$44.30
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.84
|
| Rate for Payer: Cash Price |
$31.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.84
|
| Rate for Payer: Cigna of WY Commercial |
$44.30
|
| Rate for Payer: Entrust Commercial |
$42.94
|
| Rate for Payer: First Choice Health Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.94
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.57
|
| Rate for Payer: HealthUtah PPO |
$45.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.84
|
| Rate for Payer: Multiplan Medicare/VA |
$26.19
|
| Rate for Payer: One Health Plan of WY PPO |
$44.30
|
| Rate for Payer: PacificSource Commercial |
$40.68
|
| Rate for Payer: PHCS PPO |
$44.30
|
| Rate for Payer: Three Rivers PPO |
$33.90
|
| Rate for Payer: TriWest Veterans Administration |
$27.57
|
| Rate for Payer: United Healthcare Commercial |
$43.17
|
| Rate for Payer: United Healthcare Medicare |
$27.57
|
| Rate for Payer: WINHealth Partners Commercial |
$42.94
|
| Rate for Payer: Wise Provider Network Commercial |
$42.94
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$8,244.00
|
|
|
Service Code
|
HCPCS 44150 80
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$8,244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,079.12
|
| Rate for Payer: Beech Street Commercial |
$7,831.80
|
| Rate for Payer: Cash Price |
$5,770.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,996.68
|
| Rate for Payer: Cigna of WY Commercial |
$8,079.12
|
| Rate for Payer: First Choice Health Commercial |
$7,419.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,831.80
|
| Rate for Payer: HealthUtah PPO |
$8,244.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,996.68
|
| Rate for Payer: One Health Plan of WY PPO |
$8,079.12
|
| Rate for Payer: PacificSource Commercial |
$7,419.60
|
| Rate for Payer: PHCS PPO |
$7,831.80
|
| Rate for Payer: Three Rivers PPO |
$6,183.00
|
| Rate for Payer: United Healthcare Commercial |
$7,831.80
|
| Rate for Payer: WINHealth Partners Commercial |
$7,007.40
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$8,244.00
|
|
|
Service Code
|
HCPCS 44150
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$8,244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,079.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,752.58
|
| Rate for Payer: Beech Street Commercial |
$7,831.80
|
| Rate for Payer: Cash Price |
$5,770.80
|
| Rate for Payer: Cash Price |
$5,770.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,996.68
|
| Rate for Payer: Cigna of WY Commercial |
$8,079.12
|
| Rate for Payer: First Choice Health Commercial |
$7,419.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,831.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,752.58
|
| Rate for Payer: HealthUtah PPO |
$8,244.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,996.68
|
| Rate for Payer: Multiplan Medicare/VA |
$1,489.69
|
| Rate for Payer: One Health Plan of WY PPO |
$8,079.12
|
| Rate for Payer: PacificSource Commercial |
$7,419.60
|
| Rate for Payer: PHCS PPO |
$7,831.80
|
| Rate for Payer: Three Rivers PPO |
$6,183.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,752.58
|
| Rate for Payer: United Healthcare Commercial |
$7,831.80
|
| Rate for Payer: WINHealth Partners Commercial |
$7,007.40
|
|
|
COLCT TOT ABDL W/O PRCTECT W/ILEOST/ILEOPXTS
|
Professional
|
Both
|
$8,244.00
|
|
|
Service Code
|
HCPCS 44150 AS
|
| Min. Negotiated Rate |
$1,489.69 |
| Max. Negotiated Rate |
$8,244.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$8,079.12
|
| Rate for Payer: Beech Street Commercial |
$7,831.80
|
| Rate for Payer: Cash Price |
$5,770.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,996.68
|
| Rate for Payer: Cigna of WY Commercial |
$8,079.12
|
| Rate for Payer: First Choice Health Commercial |
$7,419.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$7,831.80
|
| Rate for Payer: HealthUtah PPO |
$8,244.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,996.68
|
| Rate for Payer: One Health Plan of WY PPO |
$8,079.12
|
| Rate for Payer: PacificSource Commercial |
$7,419.60
|
| Rate for Payer: PHCS PPO |
$7,831.80
|
| Rate for Payer: Three Rivers PPO |
$6,183.00
|
| Rate for Payer: United Healthcare Commercial |
$7,831.80
|
| Rate for Payer: WINHealth Partners Commercial |
$7,007.40
|
|
|
COLD PACK INSTANT
|
Facility
|
IP
|
$1.13
|
|
| Hospital Charge Code |
2400031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.72
|
| Rate for Payer: Altius Commercial |
$1.08
|
| Rate for Payer: Beech Street Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.10
|
| Rate for Payer: Cigna of WY Commercial |
$1.11
|
| Rate for Payer: Entrust Commercial |
$1.07
|
| Rate for Payer: First Choice Health Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.69
|
| Rate for Payer: HealthUtah PPO |
$1.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.65
|
| Rate for Payer: One Health Plan of WY PPO |
$1.11
|
| Rate for Payer: PacificSource Commercial |
$1.02
|
| Rate for Payer: PHCS PPO |
$1.11
|
| Rate for Payer: Three Rivers PPO |
$0.85
|
| Rate for Payer: TriWest Veterans Administration |
$0.69
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$0.69
|
| Rate for Payer: WINHealth Partners Commercial |
$1.07
|
| Rate for Payer: Wise Provider Network Commercial |
$1.07
|
|
|
COLD PACK INSTANT
|
Facility
|
OP
|
$1.13
|
|
| Hospital Charge Code |
2400031
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$1.13 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1.11
|
| Rate for Payer: Aetna of WY Medicare |
$0.75
|
| Rate for Payer: Altius Commercial |
$1.08
|
| Rate for Payer: Beech Street Commercial |
$1.11
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1.10
|
| Rate for Payer: Cash Price |
$0.79
|
| Rate for Payer: ChoiceCare Network Commercial |
$1.10
|
| Rate for Payer: Cigna of WY Commercial |
$1.11
|
| Rate for Payer: Entrust Commercial |
$1.07
|
| Rate for Payer: First Choice Health Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.64
|
| Rate for Payer: HealthUtah PPO |
$1.13
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1.10
|
| Rate for Payer: Multiplan Medicare/VA |
$0.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1.11
|
| Rate for Payer: PacificSource Commercial |
$1.02
|
| Rate for Payer: PHCS PPO |
$1.11
|
| Rate for Payer: Three Rivers PPO |
$0.85
|
| Rate for Payer: TriWest Veterans Administration |
$0.64
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
| Rate for Payer: WINHealth Partners Commercial |
$1.11
|
| Rate for Payer: Wise Provider Network Commercial |
$1.07
|
|
|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$5,939.00
|
|
|
Service Code
|
HCPCS 44140
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$5,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,820.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,269.94
|
| Rate for Payer: Beech Street Commercial |
$5,642.05
|
| Rate for Payer: Cash Price |
$4,157.30
|
| Rate for Payer: Cash Price |
$4,157.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,760.83
|
| Rate for Payer: Cigna of WY Commercial |
$5,820.22
|
| Rate for Payer: First Choice Health Commercial |
$5,345.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,642.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,269.94
|
| Rate for Payer: HealthUtah PPO |
$5,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,760.83
|
| Rate for Payer: Multiplan Medicare/VA |
$1,079.45
|
| Rate for Payer: One Health Plan of WY PPO |
$5,820.22
|
| Rate for Payer: PacificSource Commercial |
$5,345.10
|
| Rate for Payer: PHCS PPO |
$5,642.05
|
| Rate for Payer: Three Rivers PPO |
$4,454.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,269.94
|
| Rate for Payer: United Healthcare Commercial |
$5,642.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,048.15
|
|
|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$5,939.00
|
|
|
Service Code
|
HCPCS 44140 80
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$5,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,820.22
|
| Rate for Payer: Beech Street Commercial |
$5,642.05
|
| Rate for Payer: Cash Price |
$4,157.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,760.83
|
| Rate for Payer: Cigna of WY Commercial |
$5,820.22
|
| Rate for Payer: First Choice Health Commercial |
$5,345.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,642.05
|
| Rate for Payer: HealthUtah PPO |
$5,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,760.83
|
| Rate for Payer: One Health Plan of WY PPO |
$5,820.22
|
| Rate for Payer: PacificSource Commercial |
$5,345.10
|
| Rate for Payer: PHCS PPO |
$5,642.05
|
| Rate for Payer: Three Rivers PPO |
$4,454.25
|
| Rate for Payer: United Healthcare Commercial |
$5,642.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,048.15
|
|
|
COLECTOMY PARTIAL W/ANASTOMOSIS
|
Professional
|
Both
|
$5,939.00
|
|
|
Service Code
|
HCPCS 44140 AS
|
| Min. Negotiated Rate |
$1,079.45 |
| Max. Negotiated Rate |
$5,939.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,820.22
|
| Rate for Payer: Beech Street Commercial |
$5,642.05
|
| Rate for Payer: Cash Price |
$4,157.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,760.83
|
| Rate for Payer: Cigna of WY Commercial |
$5,820.22
|
| Rate for Payer: First Choice Health Commercial |
$5,345.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,642.05
|
| Rate for Payer: HealthUtah PPO |
$5,939.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,760.83
|
| Rate for Payer: One Health Plan of WY PPO |
$5,820.22
|
| Rate for Payer: PacificSource Commercial |
$5,345.10
|
| Rate for Payer: PHCS PPO |
$5,642.05
|
| Rate for Payer: Three Rivers PPO |
$4,454.25
|
| Rate for Payer: United Healthcare Commercial |
$5,642.05
|
| Rate for Payer: WINHealth Partners Commercial |
$5,048.15
|
|
|
COLECTOMY PRTL W/END COLOSTOMY & CLSR DSTL SGMT
|
Professional
|
Both
|
$7,359.00
|
|
|
Service Code
|
HCPCS 44143
|
| Min. Negotiated Rate |
$1,325.68 |
| Max. Negotiated Rate |
$7,359.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,211.82
|
| Rate for Payer: Aetna of WY Medicare |
$1,559.62
|
| Rate for Payer: Beech Street Commercial |
$6,991.05
|
| Rate for Payer: Cash Price |
$5,151.30
|
| Rate for Payer: Cash Price |
$5,151.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,138.23
|
| Rate for Payer: Cigna of WY Commercial |
$7,211.82
|
| Rate for Payer: First Choice Health Commercial |
$6,623.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,991.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,559.62
|
| Rate for Payer: HealthUtah PPO |
$7,359.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,138.23
|
| Rate for Payer: Multiplan Medicare/VA |
$1,325.68
|
| Rate for Payer: One Health Plan of WY PPO |
$7,211.82
|
| Rate for Payer: PacificSource Commercial |
$6,623.10
|
| Rate for Payer: PHCS PPO |
$6,991.05
|
| Rate for Payer: Three Rivers PPO |
$5,519.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,559.62
|
| Rate for Payer: United Healthcare Commercial |
$6,991.05
|
| Rate for Payer: WINHealth Partners Commercial |
$6,255.15
|
|
|
COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS
|
Professional
|
Both
|
$5,494.00
|
|
|
Service Code
|
HCPCS 44160
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$5,494.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,384.12
|
| Rate for Payer: Aetna of WY Medicare |
$1,175.65
|
| Rate for Payer: Beech Street Commercial |
$5,219.30
|
| Rate for Payer: Cash Price |
$3,845.80
|
| Rate for Payer: Cash Price |
$3,845.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,329.18
|
| Rate for Payer: Cigna of WY Commercial |
$5,384.12
|
| Rate for Payer: First Choice Health Commercial |
$4,944.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,219.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,175.65
|
| Rate for Payer: HealthUtah PPO |
$5,494.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,329.18
|
| Rate for Payer: Multiplan Medicare/VA |
$999.30
|
| Rate for Payer: One Health Plan of WY PPO |
$5,384.12
|
| Rate for Payer: PacificSource Commercial |
$4,944.60
|
| Rate for Payer: PHCS PPO |
$5,219.30
|
| Rate for Payer: Three Rivers PPO |
$4,120.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,175.65
|
| Rate for Payer: United Healthcare Commercial |
$5,219.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,669.90
|
|
|
COLECTOMY PRTL W/RMVL TERMINAL ILEUM & ILEOCOLOS
|
Professional
|
Both
|
$5,494.00
|
|
|
Service Code
|
HCPCS 44160 80
|
| Min. Negotiated Rate |
$999.30 |
| Max. Negotiated Rate |
$5,494.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,384.12
|
| Rate for Payer: Beech Street Commercial |
$5,219.30
|
| Rate for Payer: Cash Price |
$3,845.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,329.18
|
| Rate for Payer: Cigna of WY Commercial |
$5,384.12
|
| Rate for Payer: First Choice Health Commercial |
$4,944.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,219.30
|
| Rate for Payer: HealthUtah PPO |
$5,494.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,329.18
|
| Rate for Payer: One Health Plan of WY PPO |
$5,384.12
|
| Rate for Payer: PacificSource Commercial |
$4,944.60
|
| Rate for Payer: PHCS PPO |
$5,219.30
|
| Rate for Payer: Three Rivers PPO |
$4,120.50
|
| Rate for Payer: United Healthcare Commercial |
$5,219.30
|
| Rate for Payer: WINHealth Partners Commercial |
$4,669.90
|
|
|
COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY
|
Professional
|
Both
|
$3,168.00
|
|
|
Service Code
|
HCPCS 44141 80
|
| Min. Negotiated Rate |
$1,456.19 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,104.64
|
| Rate for Payer: Beech Street Commercial |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,072.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,104.64
|
| Rate for Payer: First Choice Health Commercial |
$2,851.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,009.60
|
| Rate for Payer: HealthUtah PPO |
$3,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,072.96
|
| Rate for Payer: One Health Plan of WY PPO |
$3,104.64
|
| Rate for Payer: PacificSource Commercial |
$2,851.20
|
| Rate for Payer: PHCS PPO |
$3,009.60
|
| Rate for Payer: Three Rivers PPO |
$2,376.00
|
| Rate for Payer: United Healthcare Commercial |
$3,009.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,692.80
|
|
|
COLECTOMY PRTL W/SKIN LEVEL CECOST/COLOSTOMY
|
Professional
|
Both
|
$3,168.00
|
|
|
Service Code
|
HCPCS 44141
|
| Min. Negotiated Rate |
$1,456.19 |
| Max. Negotiated Rate |
$3,168.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,104.64
|
| Rate for Payer: Aetna of WY Medicare |
$1,713.16
|
| Rate for Payer: Beech Street Commercial |
$3,009.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,217.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,072.96
|
| Rate for Payer: Cigna of WY Commercial |
$3,104.64
|
| Rate for Payer: First Choice Health Commercial |
$2,851.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,009.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,713.16
|
| Rate for Payer: HealthUtah PPO |
$3,168.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,072.96
|
| Rate for Payer: Multiplan Medicare/VA |
$1,456.19
|
| Rate for Payer: One Health Plan of WY PPO |
$3,104.64
|
| Rate for Payer: PacificSource Commercial |
$2,851.20
|
| Rate for Payer: PHCS PPO |
$3,009.60
|
| Rate for Payer: Three Rivers PPO |
$2,376.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,713.16
|
| Rate for Payer: United Healthcare Commercial |
$3,009.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,692.80
|
|
|
COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
HCPCS 44155
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,967.84
|
| Rate for Payer: Aetna of WY Medicare |
$1,956.01
|
| Rate for Payer: Beech Street Commercial |
$1,907.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: Cash Price |
$1,405.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,947.76
|
| Rate for Payer: Cigna of WY Commercial |
$1,967.84
|
| Rate for Payer: First Choice Health Commercial |
$1,807.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,907.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,956.01
|
| Rate for Payer: HealthUtah PPO |
$2,008.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,947.76
|
| Rate for Payer: Multiplan Medicare/VA |
$1,662.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,967.84
|
| Rate for Payer: PacificSource Commercial |
$1,807.20
|
| Rate for Payer: PHCS PPO |
$1,907.60
|
| Rate for Payer: Three Rivers PPO |
$1,506.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,956.01
|
| Rate for Payer: United Healthcare Commercial |
$1,907.60
|
| Rate for Payer: WINHealth Partners Commercial |
$1,706.80
|
|
|
COLECTOMY TOT ABDL W/PROCTECTOMY W/ILEOSTOMY
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
HCPCS 44155 80
|
| Min. Negotiated Rate |
$300.00 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$392.00
|
| Rate for Payer: Beech Street Commercial |
$380.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$388.00
|
| Rate for Payer: Cigna of WY Commercial |
$392.00
|
| Rate for Payer: First Choice Health Commercial |
$360.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$380.00
|
| Rate for Payer: HealthUtah PPO |
$400.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$388.00
|
| Rate for Payer: One Health Plan of WY PPO |
$392.00
|
| Rate for Payer: PacificSource Commercial |
$360.00
|
| Rate for Payer: PHCS PPO |
$380.00
|
| Rate for Payer: Three Rivers PPO |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$380.00
|
| Rate for Payer: WINHealth Partners Commercial |
$340.00
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 44157 AS
|
| Min. Negotiated Rate |
$311.25 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Beech Street Commercial |
$394.25
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: First Choice Health Commercial |
$373.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$394.25
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: United Healthcare Commercial |
$394.25
|
| Rate for Payer: WINHealth Partners Commercial |
$352.75
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$415.00
|
|
|
Service Code
|
HCPCS 44157 80
|
| Min. Negotiated Rate |
$311.25 |
| Max. Negotiated Rate |
$415.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$406.70
|
| Rate for Payer: Beech Street Commercial |
$394.25
|
| Rate for Payer: Cash Price |
$290.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$402.55
|
| Rate for Payer: Cigna of WY Commercial |
$406.70
|
| Rate for Payer: First Choice Health Commercial |
$373.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$394.25
|
| Rate for Payer: HealthUtah PPO |
$415.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$402.55
|
| Rate for Payer: One Health Plan of WY PPO |
$406.70
|
| Rate for Payer: PacificSource Commercial |
$373.50
|
| Rate for Payer: PHCS PPO |
$394.25
|
| Rate for Payer: Three Rivers PPO |
$311.25
|
| Rate for Payer: United Healthcare Commercial |
$394.25
|
| Rate for Payer: WINHealth Partners Commercial |
$352.75
|
|
|
COLECTOMY TOT ABD W/PROCTECTOMY ILEOANAL ANAST
|
Professional
|
Both
|
$2,073.00
|
|
|
Service Code
|
HCPCS 44157
|
| Min. Negotiated Rate |
$1,554.75 |
| Max. Negotiated Rate |
$2,073.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,031.54
|
| Rate for Payer: Aetna of WY Medicare |
$2,061.12
|
| Rate for Payer: Beech Street Commercial |
$1,969.35
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: Cash Price |
$1,451.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,010.81
|
| Rate for Payer: Cigna of WY Commercial |
$2,031.54
|
| Rate for Payer: First Choice Health Commercial |
$1,865.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,969.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2,061.12
|
| Rate for Payer: HealthUtah PPO |
$2,073.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,010.81
|
| Rate for Payer: Multiplan Medicare/VA |
$1,751.95
|
| Rate for Payer: One Health Plan of WY PPO |
$2,031.54
|
| Rate for Payer: PacificSource Commercial |
$1,865.70
|
| Rate for Payer: PHCS PPO |
$1,969.35
|
| Rate for Payer: Three Rivers PPO |
$1,554.75
|
| Rate for Payer: TriWest Veterans Administration |
$2,061.12
|
| Rate for Payer: United Healthcare Commercial |
$1,969.35
|
| Rate for Payer: WINHealth Partners Commercial |
$1,762.05
|
|
|
COLLAGENASE, CLOST HIST INJ
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS J0775
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$89.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$87.22
|
| Rate for Payer: Aetna of WY Medicare |
$68.97
|
| 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: 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 |
$68.97
|
| Rate for Payer: HealthUtah PPO |
$89.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$86.33
|
| Rate for Payer: Multiplan Medicare/VA |
$58.62
|
| 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 |
$68.97
|
| Rate for Payer: United Healthcare Commercial |
$84.55
|
| Rate for Payer: WINHealth Partners Commercial |
$84.55
|
|
