|
COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT
|
Professional
|
Both
|
$2,560.00
|
|
|
Service Code
|
HCPCS 45386
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$2,560.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,508.80
|
| Rate for Payer: Aetna of WY Medicare |
$200.55
|
| Rate for Payer: Beech Street Commercial |
$2,432.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: Cash Price |
$1,792.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,483.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,508.80
|
| Rate for Payer: First Choice Health Commercial |
$2,304.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,432.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$200.55
|
| Rate for Payer: HealthUtah PPO |
$2,560.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,483.20
|
| Rate for Payer: Multiplan Medicare/VA |
$170.47
|
| Rate for Payer: One Health Plan of WY PPO |
$2,508.80
|
| Rate for Payer: PacificSource Commercial |
$2,304.00
|
| Rate for Payer: PHCS PPO |
$2,432.00
|
| Rate for Payer: Three Rivers PPO |
$1,920.00
|
| Rate for Payer: TriWest Veterans Administration |
$200.55
|
| Rate for Payer: United Healthcare Commercial |
$2,432.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,176.00
|
|
|
COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
HCPCS 45381
|
| Min. Negotiated Rate |
$161.30 |
| Max. Negotiated Rate |
$1,147.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,124.06
|
| Rate for Payer: Aetna of WY Medicare |
$189.76
|
| Rate for Payer: Beech Street Commercial |
$1,089.65
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: Cash Price |
$802.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,112.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,124.06
|
| Rate for Payer: First Choice Health Commercial |
$1,032.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,089.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$189.76
|
| Rate for Payer: HealthUtah PPO |
$1,147.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,112.59
|
| Rate for Payer: Multiplan Medicare/VA |
$161.30
|
| Rate for Payer: One Health Plan of WY PPO |
$1,124.06
|
| Rate for Payer: PacificSource Commercial |
$1,032.30
|
| Rate for Payer: PHCS PPO |
$1,089.65
|
| Rate for Payer: Three Rivers PPO |
$860.25
|
| Rate for Payer: TriWest Veterans Administration |
$189.76
|
| Rate for Payer: United Healthcare Commercial |
$1,089.65
|
| Rate for Payer: WINHealth Partners Commercial |
$974.95
|
|
|
COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS
|
Professional
|
Both
|
$1,707.00
|
|
|
Service Code
|
HCPCS 45384
|
| Min. Negotiated Rate |
$183.09 |
| Max. Negotiated Rate |
$1,707.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,672.86
|
| Rate for Payer: Aetna of WY Medicare |
$215.40
|
| Rate for Payer: Beech Street Commercial |
$1,621.65
|
| Rate for Payer: Cash Price |
$1,194.90
|
| Rate for Payer: Cash Price |
$1,194.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,655.79
|
| Rate for Payer: Cigna of WY Commercial |
$1,672.86
|
| Rate for Payer: First Choice Health Commercial |
$1,536.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,621.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$215.40
|
| Rate for Payer: HealthUtah PPO |
$1,707.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,655.79
|
| Rate for Payer: Multiplan Medicare/VA |
$183.09
|
| Rate for Payer: One Health Plan of WY PPO |
$1,672.86
|
| Rate for Payer: PacificSource Commercial |
$1,536.30
|
| Rate for Payer: PHCS PPO |
$1,621.65
|
| Rate for Payer: Three Rivers PPO |
$1,280.25
|
| Rate for Payer: TriWest Veterans Administration |
$215.40
|
| Rate for Payer: United Healthcare Commercial |
$1,621.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,450.95
|
|
|
COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ
|
Professional
|
Both
|
$1,956.00
|
|
|
Service Code
|
HCPCS 45385
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$1,956.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,916.88
|
| Rate for Payer: Aetna of WY Medicare |
$240.47
|
| Rate for Payer: Beech Street Commercial |
$1,858.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: Cash Price |
$1,369.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,897.32
|
| Rate for Payer: Cigna of WY Commercial |
$1,916.88
|
| Rate for Payer: First Choice Health Commercial |
$1,760.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,858.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$240.47
|
| Rate for Payer: HealthUtah PPO |
$1,956.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,897.32
|
| Rate for Payer: Multiplan Medicare/VA |
$204.40
|
| Rate for Payer: One Health Plan of WY PPO |
$1,916.88
|
| Rate for Payer: PacificSource Commercial |
$1,760.40
|
| Rate for Payer: PHCS PPO |
$1,858.20
|
| Rate for Payer: Three Rivers PPO |
$1,467.00
|
| Rate for Payer: TriWest Veterans Administration |
$240.47
|
| Rate for Payer: United Healthcare Commercial |
$1,858.20
|
| Rate for Payer: WINHealth Partners Commercial |
$1,662.60
|
|
|
COMP ASSES CARE PLAN CCM SVC
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS G0506
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$148.96
|
| Rate for Payer: Aetna of WY Medicare |
$42.38
|
| Rate for Payer: Beech Street Commercial |
$144.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$147.44
|
| Rate for Payer: Cigna of WY Commercial |
$148.96
|
| Rate for Payer: First Choice Health Commercial |
$136.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$144.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.38
|
| Rate for Payer: HealthUtah PPO |
$152.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$147.44
|
| Rate for Payer: Multiplan Medicare/VA |
$36.02
|
| Rate for Payer: One Health Plan of WY PPO |
$148.96
|
| Rate for Payer: PacificSource Commercial |
$136.80
|
| Rate for Payer: PHCS PPO |
$144.40
|
| Rate for Payer: Three Rivers PPO |
$114.00
|
| Rate for Payer: TriWest Veterans Administration |
$42.38
|
| Rate for Payer: United Healthcare Commercial |
$144.40
|
| Rate for Payer: WINHealth Partners Commercial |
$144.40
|
|
|
COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 99487
|
| Min. Negotiated Rate |
$73.72 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$204.82
|
| Rate for Payer: Aetna of WY Medicare |
$86.73
|
| Rate for Payer: Beech Street Commercial |
$198.55
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$202.73
|
| Rate for Payer: Cigna of WY Commercial |
$204.82
|
| Rate for Payer: First Choice Health Commercial |
$188.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$198.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$86.73
|
| Rate for Payer: HealthUtah PPO |
$209.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$202.73
|
| Rate for Payer: Multiplan Medicare/VA |
$73.72
|
| Rate for Payer: One Health Plan of WY PPO |
$204.82
|
| Rate for Payer: PacificSource Commercial |
$188.10
|
| Rate for Payer: PHCS PPO |
$198.55
|
| Rate for Payer: Three Rivers PPO |
$156.75
|
| Rate for Payer: TriWest Veterans Administration |
$86.73
|
| Rate for Payer: United Healthcare Commercial |
$198.55
|
| Rate for Payer: WINHealth Partners Commercial |
$198.55
|
|
|
COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 51741 26
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$8.02
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.02
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$6.82
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$8.02
|
| Rate for Payer: United Healthcare Commercial |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$40.80
|
|
|
COMPLEX UROFLOMETRY
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 51741
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$47.04
|
| Rate for Payer: Aetna of WY Medicare |
$13.82
|
| Rate for Payer: Beech Street Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$46.56
|
| Rate for Payer: Cigna of WY Commercial |
$47.04
|
| Rate for Payer: First Choice Health Commercial |
$43.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$45.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.82
|
| Rate for Payer: HealthUtah PPO |
$48.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$46.56
|
| Rate for Payer: Multiplan Medicare/VA |
$11.75
|
| Rate for Payer: One Health Plan of WY PPO |
$47.04
|
| Rate for Payer: PacificSource Commercial |
$43.20
|
| Rate for Payer: PHCS PPO |
$45.60
|
| Rate for Payer: Three Rivers PPO |
$36.00
|
| Rate for Payer: TriWest Veterans Administration |
$13.82
|
| Rate for Payer: United Healthcare Commercial |
$45.60
|
| Rate for Payer: WINHealth Partners Commercial |
$40.80
|
|
|
COMPLX CYSTOMETRO W/VOID PRESS & URETHRAL PROFIL
|
Professional
|
Both
|
$1,347.00
|
|
|
Service Code
|
HCPCS 51729
|
| Min. Negotiated Rate |
$318.25 |
| Max. Negotiated Rate |
$1,347.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,320.06
|
| Rate for Payer: Aetna of WY Medicare |
$374.41
|
| Rate for Payer: Beech Street Commercial |
$1,279.65
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,306.59
|
| Rate for Payer: Cigna of WY Commercial |
$1,320.06
|
| Rate for Payer: First Choice Health Commercial |
$1,212.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,279.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$374.41
|
| Rate for Payer: HealthUtah PPO |
$1,347.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,306.59
|
| Rate for Payer: Multiplan Medicare/VA |
$318.25
|
| Rate for Payer: One Health Plan of WY PPO |
$1,320.06
|
| Rate for Payer: PacificSource Commercial |
$1,212.30
|
| Rate for Payer: PHCS PPO |
$1,279.65
|
| Rate for Payer: Three Rivers PPO |
$1,010.25
|
| Rate for Payer: TriWest Veterans Administration |
$374.41
|
| Rate for Payer: United Healthcare Commercial |
$1,279.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,144.95
|
|
|
COMPRE AUDIOMETRY THRESHOLD EVAL SP RECOGNIJ
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 92557
|
| Min. Negotiated Rate |
$26.02 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$105.84
|
| Rate for Payer: Aetna of WY Medicare |
$30.61
|
| Rate for Payer: Beech Street Commercial |
$102.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$104.76
|
| Rate for Payer: Cigna of WY Commercial |
$105.84
|
| Rate for Payer: First Choice Health Commercial |
$97.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$102.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$30.61
|
| Rate for Payer: HealthUtah PPO |
$108.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$104.76
|
| Rate for Payer: Multiplan Medicare/VA |
$26.02
|
| Rate for Payer: One Health Plan of WY PPO |
$105.84
|
| Rate for Payer: PacificSource Commercial |
$97.20
|
| Rate for Payer: PHCS PPO |
$102.60
|
| Rate for Payer: Three Rivers PPO |
$81.00
|
| Rate for Payer: TriWest Veterans Administration |
$30.61
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: WINHealth Partners Commercial |
$102.60
|
|
|
COMPREHENSIVE METABOLIC PANEL
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 80053
|
| Min. Negotiated Rate |
$8.98 |
| Max. Negotiated Rate |
$86.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$84.28
|
| Rate for Payer: Aetna of WY Medicare |
$10.56
|
| Rate for Payer: Beech Street Commercial |
$81.70
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: Cash Price |
$60.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$83.42
|
| Rate for Payer: Cigna of WY Commercial |
$84.28
|
| Rate for Payer: First Choice Health Commercial |
$77.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$81.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.56
|
| Rate for Payer: HealthUtah PPO |
$86.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$83.42
|
| Rate for Payer: Multiplan Medicare/VA |
$8.98
|
| Rate for Payer: One Health Plan of WY PPO |
$84.28
|
| Rate for Payer: PacificSource Commercial |
$77.40
|
| Rate for Payer: PHCS PPO |
$81.70
|
| Rate for Payer: Three Rivers PPO |
$64.50
|
| Rate for Payer: TriWest Veterans Administration |
$10.56
|
| Rate for Payer: United Healthcare Commercial |
$81.70
|
| Rate for Payer: WINHealth Partners Commercial |
$81.70
|
|
|
COMPRESSION ARM SLEEVE LG/XL
|
Facility
|
IP
|
$62.96
|
|
| Hospital Charge Code |
2250003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$40.29
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.41
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$36.49
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$38.41
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
| Rate for Payer: WINHealth Partners Commercial |
$59.81
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION ARM SLEEVE LG/XL
|
Facility
|
OP
|
$62.96
|
|
| Hospital Charge Code |
2250003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$41.55
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$61.70
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION ARM SLEEVE SM/MD
|
Facility
|
IP
|
$62.96
|
|
| Hospital Charge Code |
2250002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$40.29
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.41
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$36.49
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$38.41
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
| Rate for Payer: WINHealth Partners Commercial |
$59.81
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION ARM SLEEVE SM/MD
|
Facility
|
OP
|
$62.96
|
|
| Hospital Charge Code |
2250002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$41.55
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$61.70
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION ARM SLEEVE YOUTH
|
Facility
|
OP
|
$62.96
|
|
| Hospital Charge Code |
2250001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$34.09 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$41.55
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$35.89
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$34.09
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$35.89
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$35.89
|
| Rate for Payer: WINHealth Partners Commercial |
$61.70
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION ARM SLEEVE YOUTH
|
Facility
|
IP
|
$62.96
|
|
| Hospital Charge Code |
2250001
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$62.96 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$61.70
|
| Rate for Payer: Aetna of WY Medicare |
$40.29
|
| Rate for Payer: Altius Commercial |
$60.44
|
| Rate for Payer: Beech Street Commercial |
$61.70
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.07
|
| Rate for Payer: Cash Price |
$44.08
|
| Rate for Payer: ChoiceCare Network Commercial |
$61.07
|
| Rate for Payer: Cigna of WY Commercial |
$61.70
|
| Rate for Payer: Entrust Commercial |
$59.81
|
| Rate for Payer: First Choice Health Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$59.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$38.41
|
| Rate for Payer: HealthUtah PPO |
$62.96
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$61.07
|
| Rate for Payer: Multiplan Medicare/VA |
$36.49
|
| Rate for Payer: One Health Plan of WY PPO |
$61.70
|
| Rate for Payer: PacificSource Commercial |
$56.66
|
| Rate for Payer: PHCS PPO |
$61.70
|
| Rate for Payer: Three Rivers PPO |
$47.22
|
| Rate for Payer: TriWest Veterans Administration |
$38.41
|
| Rate for Payer: United Healthcare Commercial |
$60.13
|
| Rate for Payer: United Healthcare Medicare |
$38.41
|
| Rate for Payer: WINHealth Partners Commercial |
$59.81
|
| Rate for Payer: Wise Provider Network Commercial |
$59.81
|
|
|
COMPRESSION STOCKING BK18-30
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS A6530
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$30.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.40
|
| Rate for Payer: Beech Street Commercial |
$28.50
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.10
|
| Rate for Payer: Cigna of WY Commercial |
$29.40
|
| Rate for Payer: First Choice Health Commercial |
$27.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$28.50
|
| Rate for Payer: HealthUtah PPO |
$30.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.10
|
| Rate for Payer: One Health Plan of WY PPO |
$29.40
|
| Rate for Payer: PacificSource Commercial |
$27.00
|
| Rate for Payer: PHCS PPO |
$28.50
|
| Rate for Payer: Three Rivers PPO |
$22.50
|
| Rate for Payer: United Healthcare Commercial |
$28.50
|
| Rate for Payer: WINHealth Partners Commercial |
$28.50
|
|
|
COMPRESS STKING BK30-40 SURG
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS A6531
|
| Min. Negotiated Rate |
$138.75 |
| Max. Negotiated Rate |
$185.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$181.30
|
| Rate for Payer: Beech Street Commercial |
$175.75
|
| Rate for Payer: Cash Price |
$129.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$179.45
|
| Rate for Payer: Cigna of WY Commercial |
$181.30
|
| Rate for Payer: First Choice Health Commercial |
$166.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$175.75
|
| Rate for Payer: HealthUtah PPO |
$185.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$179.45
|
| Rate for Payer: One Health Plan of WY PPO |
$181.30
|
| Rate for Payer: PacificSource Commercial |
$166.50
|
| Rate for Payer: PHCS PPO |
$175.75
|
| Rate for Payer: Three Rivers PPO |
$138.75
|
| Rate for Payer: United Healthcare Commercial |
$175.75
|
| Rate for Payer: WINHealth Partners Commercial |
$175.75
|
|
|
CONEXA PATCH 5 X 5
|
Facility
|
OP
|
$9,712.50
|
|
| Hospital Charge Code |
3001370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,259.32 |
| Max. Negotiated Rate |
$9,712.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,518.25
|
| Rate for Payer: Aetna of WY Medicare |
$6,410.25
|
| Rate for Payer: Altius Commercial |
$9,324.00
|
| Rate for Payer: Beech Street Commercial |
$9,518.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,421.12
|
| Rate for Payer: Cash Price |
$6,798.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,421.12
|
| Rate for Payer: Cigna of WY Commercial |
$9,518.25
|
| Rate for Payer: Entrust Commercial |
$9,226.88
|
| Rate for Payer: First Choice Health Commercial |
$9,226.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,226.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,536.12
|
| Rate for Payer: HealthUtah PPO |
$9,712.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,421.12
|
| Rate for Payer: Multiplan Medicare/VA |
$5,259.32
|
| Rate for Payer: One Health Plan of WY PPO |
$9,518.25
|
| Rate for Payer: PacificSource Commercial |
$8,741.25
|
| Rate for Payer: PHCS PPO |
$9,518.25
|
| Rate for Payer: Three Rivers PPO |
$7,284.38
|
| Rate for Payer: TriWest Veterans Administration |
$5,536.12
|
| Rate for Payer: United Healthcare Commercial |
$9,275.44
|
| Rate for Payer: United Healthcare Medicare |
$5,536.12
|
| Rate for Payer: WINHealth Partners Commercial |
$9,518.25
|
| Rate for Payer: Wise Provider Network Commercial |
$9,226.88
|
|
|
CONEXA PATCH 5 X 5
|
Facility
|
IP
|
$9,712.50
|
|
| Hospital Charge Code |
3001370
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,628.39 |
| Max. Negotiated Rate |
$9,712.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9,518.25
|
| Rate for Payer: Aetna of WY Medicare |
$6,216.00
|
| Rate for Payer: Altius Commercial |
$9,324.00
|
| Rate for Payer: Beech Street Commercial |
$9,518.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9,421.12
|
| Rate for Payer: Cash Price |
$6,798.75
|
| Rate for Payer: ChoiceCare Network Commercial |
$9,421.12
|
| Rate for Payer: Cigna of WY Commercial |
$9,518.25
|
| Rate for Payer: Entrust Commercial |
$9,226.88
|
| Rate for Payer: First Choice Health Commercial |
$9,226.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$9,226.88
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5,924.62
|
| Rate for Payer: HealthUtah PPO |
$9,712.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9,421.12
|
| Rate for Payer: Multiplan Medicare/VA |
$5,628.39
|
| Rate for Payer: One Health Plan of WY PPO |
$9,518.25
|
| Rate for Payer: PacificSource Commercial |
$8,741.25
|
| Rate for Payer: PHCS PPO |
$9,518.25
|
| Rate for Payer: Three Rivers PPO |
$7,284.38
|
| Rate for Payer: TriWest Veterans Administration |
$5,924.62
|
| Rate for Payer: United Healthcare Commercial |
$9,275.44
|
| Rate for Payer: United Healthcare Medicare |
$5,924.62
|
| Rate for Payer: WINHealth Partners Commercial |
$9,226.88
|
| Rate for Payer: Wise Provider Network Commercial |
$9,226.88
|
|
|
CONFORM 1" BANDAGE GAUZE
|
Facility
|
OP
|
$0.56
|
|
| Hospital Charge Code |
2000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.30 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.37
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.32
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.30
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.32
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
| Rate for Payer: WINHealth Partners Commercial |
$0.55
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
CONFORM 1" BANDAGE GAUZE
|
Facility
|
IP
|
$0.56
|
|
| Hospital Charge Code |
2000011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$0.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.55
|
| Rate for Payer: Aetna of WY Medicare |
$0.36
|
| Rate for Payer: Altius Commercial |
$0.54
|
| Rate for Payer: Beech Street Commercial |
$0.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.54
|
| Rate for Payer: Cigna of WY Commercial |
$0.55
|
| Rate for Payer: Entrust Commercial |
$0.53
|
| Rate for Payer: First Choice Health Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.53
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.34
|
| Rate for Payer: HealthUtah PPO |
$0.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.54
|
| Rate for Payer: Multiplan Medicare/VA |
$0.32
|
| Rate for Payer: One Health Plan of WY PPO |
$0.55
|
| Rate for Payer: PacificSource Commercial |
$0.50
|
| Rate for Payer: PHCS PPO |
$0.55
|
| Rate for Payer: Three Rivers PPO |
$0.42
|
| Rate for Payer: TriWest Veterans Administration |
$0.34
|
| Rate for Payer: United Healthcare Commercial |
$0.53
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
| Rate for Payer: WINHealth Partners Commercial |
$0.53
|
| Rate for Payer: Wise Provider Network Commercial |
$0.53
|
|
|
CONFORM 2" BANDAGE GAUZE
|
Facility
|
OP
|
$0.46
|
|
| Hospital Charge Code |
2000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.25 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.30
|
| Rate for Payer: Altius Commercial |
$0.44
|
| Rate for Payer: Beech Street Commercial |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.45
|
| Rate for Payer: Cigna of WY Commercial |
$0.45
|
| Rate for Payer: Entrust Commercial |
$0.44
|
| Rate for Payer: First Choice Health Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.26
|
| Rate for Payer: HealthUtah PPO |
$0.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.45
|
| Rate for Payer: Multiplan Medicare/VA |
$0.25
|
| Rate for Payer: One Health Plan of WY PPO |
$0.45
|
| Rate for Payer: PacificSource Commercial |
$0.41
|
| Rate for Payer: PHCS PPO |
$0.45
|
| Rate for Payer: Three Rivers PPO |
$0.35
|
| Rate for Payer: TriWest Veterans Administration |
$0.26
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.26
|
| Rate for Payer: WINHealth Partners Commercial |
$0.45
|
| Rate for Payer: Wise Provider Network Commercial |
$0.44
|
|
|
CONFORM 2" BANDAGE GAUZE
|
Facility
|
IP
|
$0.46
|
|
| Hospital Charge Code |
2000010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$0.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.45
|
| Rate for Payer: Aetna of WY Medicare |
$0.29
|
| Rate for Payer: Altius Commercial |
$0.44
|
| Rate for Payer: Beech Street Commercial |
$0.45
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.45
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.45
|
| Rate for Payer: Cigna of WY Commercial |
$0.45
|
| Rate for Payer: Entrust Commercial |
$0.44
|
| Rate for Payer: First Choice Health Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.28
|
| Rate for Payer: HealthUtah PPO |
$0.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.45
|
| Rate for Payer: Multiplan Medicare/VA |
$0.27
|
| Rate for Payer: One Health Plan of WY PPO |
$0.45
|
| Rate for Payer: PacificSource Commercial |
$0.41
|
| Rate for Payer: PHCS PPO |
$0.45
|
| Rate for Payer: Three Rivers PPO |
$0.35
|
| Rate for Payer: TriWest Veterans Administration |
$0.28
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.28
|
| Rate for Payer: WINHealth Partners Commercial |
$0.44
|
| Rate for Payer: Wise Provider Network Commercial |
$0.44
|
|
