|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [23877]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.27 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$54.00
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$46.18
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$37.12
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$35.27
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$37.12
|
| Rate for Payer: United Healthcare Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare |
$37.12
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$3,146.00
|
|
|
Service Code
|
HCPCS 44121
|
| Hospital Charge Code |
44121
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$3,146.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,083.08
|
| Rate for Payer: Aetna of WY Medicare |
$224.98
|
| Rate for Payer: Beech Street Commercial |
$2,988.70
|
| Rate for Payer: Cash Price |
$2,202.20
|
| Rate for Payer: Cash Price |
$2,202.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,051.62
|
| Rate for Payer: Cigna of WY Commercial |
$3,083.08
|
| Rate for Payer: First Choice Health Commercial |
$2,831.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,988.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.98
|
| Rate for Payer: HealthUtah PPO |
$3,146.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,051.62
|
| Rate for Payer: Multiplan Medicare/VA |
$191.23
|
| Rate for Payer: One Health Plan of WY PPO |
$3,083.08
|
| Rate for Payer: PacificSource Commercial |
$2,831.40
|
| Rate for Payer: PHCS PPO |
$2,988.70
|
| Rate for Payer: Three Rivers PPO |
$2,359.50
|
| Rate for Payer: TriWest Veterans Administration |
$224.98
|
| Rate for Payer: United Healthcare Commercial |
$2,737.02
|
| Rate for Payer: United Healthcare Medicare |
$224.98
|
| Rate for Payer: WINHealth Partners Commercial |
$2,674.10
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$5,662.00
|
|
|
Service Code
|
HCPCS 44005 AS
|
| Hospital Charge Code |
44005
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,548.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,032.78
|
| Rate for Payer: Beech Street Commercial |
$5,378.90
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,492.14
|
| Rate for Payer: Cigna of WY Commercial |
$5,548.76
|
| Rate for Payer: First Choice Health Commercial |
$5,095.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,378.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,032.78
|
| Rate for Payer: HealthUtah PPO |
$5,662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,492.14
|
| Rate for Payer: Multiplan Medicare/VA |
$877.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,548.76
|
| Rate for Payer: PacificSource Commercial |
$5,095.80
|
| Rate for Payer: PHCS PPO |
$5,378.90
|
| Rate for Payer: Three Rivers PPO |
$4,246.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,032.78
|
| Rate for Payer: United Healthcare Commercial |
$4,925.94
|
| Rate for Payer: United Healthcare Medicare |
$1,032.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,812.70
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$5,662.00
|
|
|
Service Code
|
HCPCS 44005 80
|
| Hospital Charge Code |
44005
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,548.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,032.78
|
| Rate for Payer: Beech Street Commercial |
$5,378.90
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,492.14
|
| Rate for Payer: Cigna of WY Commercial |
$5,548.76
|
| Rate for Payer: First Choice Health Commercial |
$5,095.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,378.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,032.78
|
| Rate for Payer: HealthUtah PPO |
$5,662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,492.14
|
| Rate for Payer: Multiplan Medicare/VA |
$877.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,548.76
|
| Rate for Payer: PacificSource Commercial |
$5,095.80
|
| Rate for Payer: PHCS PPO |
$5,378.90
|
| Rate for Payer: Three Rivers PPO |
$4,246.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,032.78
|
| Rate for Payer: United Healthcare Commercial |
$4,925.94
|
| Rate for Payer: United Healthcare Medicare |
$1,032.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,812.70
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$5,662.00
|
|
|
Service Code
|
HCPCS 44005
|
| Hospital Charge Code |
44005
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$5,662.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,548.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,032.78
|
| Rate for Payer: Beech Street Commercial |
$5,378.90
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: Cash Price |
$3,963.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,492.14
|
| Rate for Payer: Cigna of WY Commercial |
$5,548.76
|
| Rate for Payer: First Choice Health Commercial |
$5,095.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,378.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,032.78
|
| Rate for Payer: HealthUtah PPO |
$5,662.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,492.14
|
| Rate for Payer: Multiplan Medicare/VA |
$877.86
|
| Rate for Payer: One Health Plan of WY PPO |
$5,548.76
|
| Rate for Payer: PacificSource Commercial |
$5,095.80
|
| Rate for Payer: PHCS PPO |
$5,378.90
|
| Rate for Payer: Three Rivers PPO |
$4,246.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,032.78
|
| Rate for Payer: United Healthcare Commercial |
$4,925.94
|
| Rate for Payer: United Healthcare Medicare |
$1,032.78
|
| Rate for Payer: WINHealth Partners Commercial |
$4,812.70
|
|
|
ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 44603
|
| Hospital Charge Code |
44603
|
| Min. Negotiated Rate |
$1,296.26 |
| Max. Negotiated Rate |
$3,290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,224.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,525.01
|
| Rate for Payer: Beech Street Commercial |
$3,125.50
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,191.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,224.20
|
| Rate for Payer: First Choice Health Commercial |
$2,961.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,125.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,525.01
|
| Rate for Payer: HealthUtah PPO |
$3,290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,191.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,296.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3,224.20
|
| Rate for Payer: PacificSource Commercial |
$2,961.00
|
| Rate for Payer: PHCS PPO |
$3,125.50
|
| Rate for Payer: Three Rivers PPO |
$2,467.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,525.01
|
| Rate for Payer: United Healthcare Commercial |
$2,862.30
|
| Rate for Payer: United Healthcare Medicare |
$1,525.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,796.50
|
|
|
ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 44603 80
|
| Hospital Charge Code |
44603
|
| Min. Negotiated Rate |
$1,296.26 |
| Max. Negotiated Rate |
$3,290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,224.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,525.01
|
| Rate for Payer: Beech Street Commercial |
$3,125.50
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,191.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,224.20
|
| Rate for Payer: First Choice Health Commercial |
$2,961.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,125.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,525.01
|
| Rate for Payer: HealthUtah PPO |
$3,290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,191.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,296.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3,224.20
|
| Rate for Payer: PacificSource Commercial |
$2,961.00
|
| Rate for Payer: PHCS PPO |
$3,125.50
|
| Rate for Payer: Three Rivers PPO |
$2,467.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,525.01
|
| Rate for Payer: United Healthcare Commercial |
$2,862.30
|
| Rate for Payer: United Healthcare Medicare |
$1,525.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,796.50
|
|
|
ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$3,290.00
|
|
|
Service Code
|
HCPCS 44603 AS
|
| Hospital Charge Code |
44603
|
| Min. Negotiated Rate |
$1,296.26 |
| Max. Negotiated Rate |
$3,290.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,224.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,525.01
|
| Rate for Payer: Beech Street Commercial |
$3,125.50
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: Cash Price |
$2,303.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,191.30
|
| Rate for Payer: Cigna of WY Commercial |
$3,224.20
|
| Rate for Payer: First Choice Health Commercial |
$2,961.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,125.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,525.01
|
| Rate for Payer: HealthUtah PPO |
$3,290.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,191.30
|
| Rate for Payer: Multiplan Medicare/VA |
$1,296.26
|
| Rate for Payer: One Health Plan of WY PPO |
$3,224.20
|
| Rate for Payer: PacificSource Commercial |
$2,961.00
|
| Rate for Payer: PHCS PPO |
$3,125.50
|
| Rate for Payer: Three Rivers PPO |
$2,467.50
|
| Rate for Payer: TriWest Veterans Administration |
$1,525.01
|
| Rate for Payer: United Healthcare Commercial |
$2,862.30
|
| Rate for Payer: United Healthcare Medicare |
$1,525.01
|
| Rate for Payer: WINHealth Partners Commercial |
$2,796.50
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$7,301.00
|
|
|
Service Code
|
HCPCS 44602 AS
|
| Hospital Charge Code |
44602
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$7,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,154.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,324.65
|
| Rate for Payer: Beech Street Commercial |
$6,935.95
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,081.97
|
| Rate for Payer: Cigna of WY Commercial |
$7,154.98
|
| Rate for Payer: First Choice Health Commercial |
$6,570.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,935.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,324.65
|
| Rate for Payer: HealthUtah PPO |
$7,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,081.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,125.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7,154.98
|
| Rate for Payer: PacificSource Commercial |
$6,570.90
|
| Rate for Payer: PHCS PPO |
$6,935.95
|
| Rate for Payer: Three Rivers PPO |
$5,475.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,324.65
|
| Rate for Payer: United Healthcare Commercial |
$6,351.87
|
| Rate for Payer: United Healthcare Medicare |
$1,324.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6,205.85
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$7,301.00
|
|
|
Service Code
|
HCPCS 44602 80
|
| Hospital Charge Code |
44602
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$7,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,154.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,324.65
|
| Rate for Payer: Beech Street Commercial |
$6,935.95
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,081.97
|
| Rate for Payer: Cigna of WY Commercial |
$7,154.98
|
| Rate for Payer: First Choice Health Commercial |
$6,570.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,935.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,324.65
|
| Rate for Payer: HealthUtah PPO |
$7,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,081.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,125.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7,154.98
|
| Rate for Payer: PacificSource Commercial |
$6,570.90
|
| Rate for Payer: PHCS PPO |
$6,935.95
|
| Rate for Payer: Three Rivers PPO |
$5,475.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,324.65
|
| Rate for Payer: United Healthcare Commercial |
$6,351.87
|
| Rate for Payer: United Healthcare Medicare |
$1,324.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6,205.85
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$7,301.00
|
|
|
Service Code
|
HCPCS 44602
|
| Hospital Charge Code |
44602
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$7,301.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$7,154.98
|
| Rate for Payer: Aetna of WY Medicare |
$1,324.65
|
| Rate for Payer: Beech Street Commercial |
$6,935.95
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: Cash Price |
$5,110.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$7,081.97
|
| Rate for Payer: Cigna of WY Commercial |
$7,154.98
|
| Rate for Payer: First Choice Health Commercial |
$6,570.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,935.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,324.65
|
| Rate for Payer: HealthUtah PPO |
$7,301.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$7,081.97
|
| Rate for Payer: Multiplan Medicare/VA |
$1,125.95
|
| Rate for Payer: One Health Plan of WY PPO |
$7,154.98
|
| Rate for Payer: PacificSource Commercial |
$6,570.90
|
| Rate for Payer: PHCS PPO |
$6,935.95
|
| Rate for Payer: Three Rivers PPO |
$5,475.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,324.65
|
| Rate for Payer: United Healthcare Commercial |
$6,351.87
|
| Rate for Payer: United Healthcare Medicare |
$1,324.65
|
| Rate for Payer: WINHealth Partners Commercial |
$6,205.85
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$6,333.00
|
|
|
Service Code
|
HCPCS 44120 80
|
| Hospital Charge Code |
44120
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,206.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.87
|
| Rate for Payer: Beech Street Commercial |
$6,016.35
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,143.01
|
| Rate for Payer: Cigna of WY Commercial |
$6,206.34
|
| Rate for Payer: First Choice Health Commercial |
$5,699.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,016.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.87
|
| Rate for Payer: HealthUtah PPO |
$6,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,143.01
|
| Rate for Payer: Multiplan Medicare/VA |
$981.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,206.34
|
| Rate for Payer: PacificSource Commercial |
$5,699.70
|
| Rate for Payer: PHCS PPO |
$6,016.35
|
| Rate for Payer: Three Rivers PPO |
$4,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.87
|
| Rate for Payer: United Healthcare Commercial |
$5,509.71
|
| Rate for Payer: United Healthcare Medicare |
$1,154.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,383.05
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$6,333.00
|
|
|
Service Code
|
HCPCS 44120
|
| Hospital Charge Code |
44120
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,206.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.87
|
| Rate for Payer: Beech Street Commercial |
$6,016.35
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,143.01
|
| Rate for Payer: Cigna of WY Commercial |
$6,206.34
|
| Rate for Payer: First Choice Health Commercial |
$5,699.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,016.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.87
|
| Rate for Payer: HealthUtah PPO |
$6,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,143.01
|
| Rate for Payer: Multiplan Medicare/VA |
$981.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,206.34
|
| Rate for Payer: PacificSource Commercial |
$5,699.70
|
| Rate for Payer: PHCS PPO |
$6,016.35
|
| Rate for Payer: Three Rivers PPO |
$4,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.87
|
| Rate for Payer: United Healthcare Commercial |
$5,509.71
|
| Rate for Payer: United Healthcare Medicare |
$1,154.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,383.05
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$6,333.00
|
|
|
Service Code
|
HCPCS 44120 AS
|
| Hospital Charge Code |
44120
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,206.34
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.87
|
| Rate for Payer: Beech Street Commercial |
$6,016.35
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: Cash Price |
$4,433.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,143.01
|
| Rate for Payer: Cigna of WY Commercial |
$6,206.34
|
| Rate for Payer: First Choice Health Commercial |
$5,699.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,016.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.87
|
| Rate for Payer: HealthUtah PPO |
$6,333.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,143.01
|
| Rate for Payer: Multiplan Medicare/VA |
$981.64
|
| Rate for Payer: One Health Plan of WY PPO |
$6,206.34
|
| Rate for Payer: PacificSource Commercial |
$5,699.70
|
| Rate for Payer: PHCS PPO |
$6,016.35
|
| Rate for Payer: Three Rivers PPO |
$4,749.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.87
|
| Rate for Payer: United Healthcare Commercial |
$5,509.71
|
| Rate for Payer: United Healthcare Medicare |
$1,154.87
|
| Rate for Payer: WINHealth Partners Commercial |
$5,383.05
|
|
|
EO ADJ JT PREFAB CUSTOM FIT
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
L3760
|
| Min. Negotiated Rate |
$176.25 |
| Max. Negotiated Rate |
$541.39 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$230.30
|
| Rate for Payer: Aetna of WY Medicare |
$541.39
|
| Rate for Payer: Beech Street Commercial |
$223.25
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: Cash Price |
$164.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$227.95
|
| Rate for Payer: Cigna of WY Commercial |
$230.30
|
| Rate for Payer: First Choice Health Commercial |
$211.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$223.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$541.39
|
| Rate for Payer: HealthUtah PPO |
$235.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$227.95
|
| Rate for Payer: Multiplan Medicare/VA |
$460.18
|
| Rate for Payer: One Health Plan of WY PPO |
$230.30
|
| Rate for Payer: PacificSource Commercial |
$211.50
|
| Rate for Payer: PHCS PPO |
$223.25
|
| Rate for Payer: Three Rivers PPO |
$176.25
|
| Rate for Payer: TriWest Veterans Administration |
$541.39
|
| Rate for Payer: United Healthcare Commercial |
$204.45
|
| Rate for Payer: United Healthcare Medicare |
$541.39
|
| Rate for Payer: WINHealth Partners Commercial |
$223.25
|
|
|
EO W/O JOINTS CF
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
L3702
|
| Min. Negotiated Rate |
$265.71 |
| Max. Negotiated Rate |
$429.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$420.42
|
| Rate for Payer: Aetna of WY Medicare |
$312.60
|
| Rate for Payer: Beech Street Commercial |
$407.55
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$416.13
|
| Rate for Payer: Cigna of WY Commercial |
$420.42
|
| Rate for Payer: First Choice Health Commercial |
$386.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$407.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$312.60
|
| Rate for Payer: HealthUtah PPO |
$429.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$416.13
|
| Rate for Payer: Multiplan Medicare/VA |
$265.71
|
| Rate for Payer: One Health Plan of WY PPO |
$420.42
|
| Rate for Payer: PacificSource Commercial |
$386.10
|
| Rate for Payer: PHCS PPO |
$407.55
|
| Rate for Payer: Three Rivers PPO |
$321.75
|
| Rate for Payer: TriWest Veterans Administration |
$312.60
|
| Rate for Payer: United Healthcare Commercial |
$373.23
|
| Rate for Payer: United Healthcare Medicare |
$312.60
|
| Rate for Payer: WINHealth Partners Commercial |
$407.55
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [145503]
|
Facility
|
OP
|
$73.08
|
|
|
Service Code
|
NDC 4202321601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Aetna of WY Medicare |
$48.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$70.16
|
| Rate for Payer: Altius Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$51.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.89
|
| Rate for Payer: Cigna of WY Commercial |
$71.62
|
| Rate for Payer: Entrust Commercial |
$69.43
|
| Rate for Payer: First Choice Health Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.39
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$40.27
|
| Rate for Payer: One Health Plan of WY PPO |
$71.62
|
| Rate for Payer: PacificSource Commercial |
$65.77
|
| Rate for Payer: PHCS PPO |
$71.62
|
| Rate for Payer: Three Rivers PPO |
$54.81
|
| Rate for Payer: TriWest Veterans Administration |
$42.39
|
| Rate for Payer: United Healthcare Commercial |
$63.58
|
| Rate for Payer: United Healthcare Medicare |
$42.39
|
| Rate for Payer: WINHealth Partners Commercial |
$71.62
|
| Rate for Payer: Wise Provider Network Commercial |
$69.43
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [145503]
|
Facility
|
IP
|
$73.08
|
|
|
Service Code
|
NDC 4202321625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$70.16
|
| Rate for Payer: Altius Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$51.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.89
|
| Rate for Payer: Cigna of WY Commercial |
$71.62
|
| Rate for Payer: Entrust Commercial |
$69.43
|
| Rate for Payer: First Choice Health Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.23
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$45.82
|
| Rate for Payer: One Health Plan of WY PPO |
$71.62
|
| Rate for Payer: PacificSource Commercial |
$65.77
|
| Rate for Payer: PHCS PPO |
$71.62
|
| Rate for Payer: Three Rivers PPO |
$54.81
|
| Rate for Payer: TriWest Veterans Administration |
$48.23
|
| Rate for Payer: United Healthcare Commercial |
$63.58
|
| Rate for Payer: United Healthcare Medicare |
$48.23
|
| Rate for Payer: WINHealth Partners Commercial |
$69.43
|
| Rate for Payer: Wise Provider Network Commercial |
$69.43
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [145503]
|
Facility
|
OP
|
$73.08
|
|
|
Service Code
|
NDC 4202321625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.27 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Aetna of WY Medicare |
$48.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$70.16
|
| Rate for Payer: Altius Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$51.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.89
|
| Rate for Payer: Cigna of WY Commercial |
$71.62
|
| Rate for Payer: Entrust Commercial |
$69.43
|
| Rate for Payer: First Choice Health Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$42.39
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$40.27
|
| Rate for Payer: One Health Plan of WY PPO |
$71.62
|
| Rate for Payer: PacificSource Commercial |
$65.77
|
| Rate for Payer: PHCS PPO |
$71.62
|
| Rate for Payer: Three Rivers PPO |
$54.81
|
| Rate for Payer: TriWest Veterans Administration |
$42.39
|
| Rate for Payer: United Healthcare Commercial |
$63.58
|
| Rate for Payer: United Healthcare Medicare |
$42.39
|
| Rate for Payer: WINHealth Partners Commercial |
$71.62
|
| Rate for Payer: Wise Provider Network Commercial |
$69.43
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [145503]
|
Facility
|
IP
|
$73.08
|
|
|
Service Code
|
NDC 4202321601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Altius Auto/Workers Compensation |
$70.16
|
| Rate for Payer: Altius Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$51.16
|
| Rate for Payer: ChoiceCare Network Commercial |
$70.89
|
| Rate for Payer: Cigna of WY Commercial |
$71.62
|
| Rate for Payer: Entrust Commercial |
$69.43
|
| Rate for Payer: First Choice Health Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$69.43
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$48.23
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$45.82
|
| Rate for Payer: One Health Plan of WY PPO |
$71.62
|
| Rate for Payer: PacificSource Commercial |
$65.77
|
| Rate for Payer: PHCS PPO |
$71.62
|
| Rate for Payer: Three Rivers PPO |
$54.81
|
| Rate for Payer: TriWest Veterans Administration |
$48.23
|
| Rate for Payer: United Healthcare Commercial |
$63.58
|
| Rate for Payer: United Healthcare Medicare |
$48.23
|
| Rate for Payer: WINHealth Partners Commercial |
$69.43
|
| Rate for Payer: Wise Provider Network Commercial |
$69.43
|
|
|
EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD
|
Professional
|
Both
|
$3,463.00
|
|
|
Service Code
|
HCPCS 15110
|
| Hospital Charge Code |
15110
|
| Min. Negotiated Rate |
$582.59 |
| Max. Negotiated Rate |
$3,463.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,393.74
|
| Rate for Payer: Aetna of WY Medicare |
$685.40
|
| Rate for Payer: Beech Street Commercial |
$3,289.85
|
| Rate for Payer: Cash Price |
$2,424.10
|
| Rate for Payer: Cash Price |
$2,424.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,359.11
|
| Rate for Payer: Cigna of WY Commercial |
$3,393.74
|
| Rate for Payer: First Choice Health Commercial |
$3,116.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,289.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$685.40
|
| Rate for Payer: HealthUtah PPO |
$3,463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,359.11
|
| Rate for Payer: Multiplan Medicare/VA |
$582.59
|
| Rate for Payer: One Health Plan of WY PPO |
$3,393.74
|
| Rate for Payer: PacificSource Commercial |
$3,116.70
|
| Rate for Payer: PHCS PPO |
$3,289.85
|
| Rate for Payer: Three Rivers PPO |
$2,597.25
|
| Rate for Payer: TriWest Veterans Administration |
$685.40
|
| Rate for Payer: United Healthcare Commercial |
$3,012.81
|
| Rate for Payer: United Healthcare Medicare |
$685.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,943.55
|
|
|
EPIDURAL SET 17G X 3.5" & 19G CATHETER
|
Facility
|
OP
|
$43.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.95
|
| Rate for Payer: Aetna of WY Medicare |
$28.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.08
|
| Rate for Payer: Altius Commercial |
$42.08
|
| Rate for Payer: Beech Street Commercial |
$42.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.98
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.52
|
| Rate for Payer: Cigna of WY Commercial |
$42.95
|
| Rate for Payer: Entrust Commercial |
$41.64
|
| Rate for Payer: First Choice Health Commercial |
$41.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.42
|
| Rate for Payer: HealthUtah PPO |
$43.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.52
|
| Rate for Payer: Multiplan Medicare/VA |
$24.15
|
| Rate for Payer: One Health Plan of WY PPO |
$42.95
|
| Rate for Payer: PacificSource Commercial |
$39.45
|
| Rate for Payer: PHCS PPO |
$42.95
|
| Rate for Payer: Three Rivers PPO |
$32.87
|
| Rate for Payer: TriWest Veterans Administration |
$25.42
|
| Rate for Payer: United Healthcare Commercial |
$38.13
|
| Rate for Payer: United Healthcare Medicare |
$25.42
|
| Rate for Payer: WINHealth Partners Commercial |
$42.95
|
| Rate for Payer: Wise Provider Network Commercial |
$41.64
|
|
|
EPIDURAL SET 17G X 3.5" & 19G CATHETER
|
Facility
|
IP
|
$43.83
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.48 |
| Max. Negotiated Rate |
$43.83 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$42.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$42.08
|
| Rate for Payer: Altius Commercial |
$42.08
|
| Rate for Payer: Beech Street Commercial |
$42.95
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$35.98
|
| Rate for Payer: Cash Price |
$30.68
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.52
|
| Rate for Payer: Cigna of WY Commercial |
$42.95
|
| Rate for Payer: Entrust Commercial |
$41.64
|
| Rate for Payer: First Choice Health Commercial |
$41.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.64
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.93
|
| Rate for Payer: HealthUtah PPO |
$43.83
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.52
|
| Rate for Payer: Multiplan Medicare/VA |
$27.48
|
| Rate for Payer: One Health Plan of WY PPO |
$42.95
|
| Rate for Payer: PacificSource Commercial |
$39.45
|
| Rate for Payer: PHCS PPO |
$42.95
|
| Rate for Payer: Three Rivers PPO |
$32.87
|
| Rate for Payer: TriWest Veterans Administration |
$28.93
|
| Rate for Payer: United Healthcare Commercial |
$38.13
|
| Rate for Payer: United Healthcare Medicare |
$28.93
|
| Rate for Payer: WINHealth Partners Commercial |
$41.64
|
| Rate for Payer: Wise Provider Network Commercial |
$41.64
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE [13791]
|
Facility
|
OP
|
$19.08
|
|
|
Service Code
|
HCPCS J0171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$19.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.09
|
| Rate for Payer: Aetna of WY Medicare |
$12.59
|
| Rate for Payer: Aetna of WY Medicare |
$13.53
|
| Rate for Payer: Aetna of WY Medicare |
$12.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.68
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Altius Commercial |
$19.68
|
| Rate for Payer: Altius Commercial |
$18.18
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Beech Street Commercial |
$20.09
|
| Rate for Payer: Beech Street Commercial |
$18.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.83
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.37
|
| Rate for Payer: Cigna of WY Commercial |
$20.09
|
| Rate for Payer: Cigna of WY Commercial |
$18.56
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Entrust Commercial |
$19.48
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: Entrust Commercial |
$17.99
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$17.99
|
| Rate for Payer: First Choice Health Commercial |
$19.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.89
|
| Rate for Payer: HealthUtah PPO |
$18.94
|
| Rate for Payer: HealthUtah PPO |
$20.50
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.37
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Multiplan Medicare/VA |
$10.44
|
| Rate for Payer: Multiplan Medicare/VA |
$10.51
|
| Rate for Payer: Multiplan Medicare/VA |
$11.30
|
| Rate for Payer: One Health Plan of WY PPO |
$18.56
|
| Rate for Payer: One Health Plan of WY PPO |
$20.09
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: PacificSource Commercial |
$18.45
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PacificSource Commercial |
$17.05
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: PHCS PPO |
$18.56
|
| Rate for Payer: PHCS PPO |
$20.09
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$15.38
|
| Rate for Payer: TriWest Veterans Administration |
$11.89
|
| Rate for Payer: TriWest Veterans Administration |
$11.07
|
| Rate for Payer: TriWest Veterans Administration |
$10.99
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Commercial |
$17.84
|
| Rate for Payer: United Healthcare Medicare |
$11.89
|
| Rate for Payer: United Healthcare Medicare |
$10.99
|
| Rate for Payer: United Healthcare Medicare |
$11.07
|
| Rate for Payer: WINHealth Partners Commercial |
$20.09
|
| Rate for Payer: WINHealth Partners Commercial |
$18.56
|
| Rate for Payer: WINHealth Partners Commercial |
$18.70
|
| Rate for Payer: Wise Provider Network Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$19.48
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
|
|
EPINEPHRINE 0.1 MG/ML INJECTION SYRINGE [13791]
|
Facility
|
IP
|
$18.94
|
|
|
Service Code
|
HCPCS J0171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$18.94 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.56
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$18.70
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$18.32
|
| Rate for Payer: Altius Auto/Workers Compensation |
$19.68
|
| Rate for Payer: Altius Commercial |
$18.32
|
| Rate for Payer: Altius Commercial |
$18.18
|
| Rate for Payer: Altius Commercial |
$19.68
|
| Rate for Payer: Beech Street Commercial |
$20.09
|
| Rate for Payer: Beech Street Commercial |
$18.70
|
| Rate for Payer: Beech Street Commercial |
$18.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$16.83
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$15.66
|
| Rate for Payer: Cash Price |
$13.36
|
| Rate for Payer: Cash Price |
$13.26
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.37
|
| Rate for Payer: ChoiceCare Network Commercial |
$19.88
|
| Rate for Payer: ChoiceCare Network Commercial |
$18.51
|
| Rate for Payer: Cigna of WY Commercial |
$18.70
|
| Rate for Payer: Cigna of WY Commercial |
$20.09
|
| Rate for Payer: Cigna of WY Commercial |
$18.56
|
| Rate for Payer: Entrust Commercial |
$19.48
|
| Rate for Payer: Entrust Commercial |
$17.99
|
| Rate for Payer: Entrust Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$18.13
|
| Rate for Payer: First Choice Health Commercial |
$19.48
|
| Rate for Payer: First Choice Health Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.48
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$18.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.53
|
| Rate for Payer: HealthUtah PPO |
$18.94
|
| Rate for Payer: HealthUtah PPO |
$19.08
|
| Rate for Payer: HealthUtah PPO |
$20.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$19.88
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.51
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$18.37
|
| Rate for Payer: Multiplan Medicare/VA |
$12.85
|
| Rate for Payer: Multiplan Medicare/VA |
$11.88
|
| Rate for Payer: Multiplan Medicare/VA |
$11.96
|
| Rate for Payer: One Health Plan of WY PPO |
$18.56
|
| Rate for Payer: One Health Plan of WY PPO |
$18.70
|
| Rate for Payer: One Health Plan of WY PPO |
$20.09
|
| Rate for Payer: PacificSource Commercial |
$18.45
|
| Rate for Payer: PacificSource Commercial |
$17.05
|
| Rate for Payer: PacificSource Commercial |
$17.17
|
| Rate for Payer: PHCS PPO |
$18.70
|
| Rate for Payer: PHCS PPO |
$18.56
|
| Rate for Payer: PHCS PPO |
$20.09
|
| Rate for Payer: Three Rivers PPO |
$14.31
|
| Rate for Payer: Three Rivers PPO |
$14.20
|
| Rate for Payer: Three Rivers PPO |
$15.38
|
| Rate for Payer: TriWest Veterans Administration |
$12.59
|
| Rate for Payer: TriWest Veterans Administration |
$12.50
|
| Rate for Payer: TriWest Veterans Administration |
$13.53
|
| Rate for Payer: United Healthcare Commercial |
$16.48
|
| Rate for Payer: United Healthcare Commercial |
$17.84
|
| Rate for Payer: United Healthcare Commercial |
$16.60
|
| Rate for Payer: United Healthcare Medicare |
$12.50
|
| Rate for Payer: United Healthcare Medicare |
$13.53
|
| Rate for Payer: United Healthcare Medicare |
$12.59
|
| Rate for Payer: WINHealth Partners Commercial |
$18.13
|
| Rate for Payer: WINHealth Partners Commercial |
$17.99
|
| Rate for Payer: WINHealth Partners Commercial |
$19.48
|
| Rate for Payer: Wise Provider Network Commercial |
$19.48
|
| Rate for Payer: Wise Provider Network Commercial |
$17.99
|
| Rate for Payer: Wise Provider Network Commercial |
$18.13
|
|
