|
AQUAMANTIS 6.0 BIPOLAR SEALER
|
Facility
|
IP
|
$1,221.99
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$766.19 |
| Max. Negotiated Rate |
$1,221.99 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,197.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,173.11
|
| Rate for Payer: Altius Commercial |
$1,173.11
|
| Rate for Payer: Beech Street Commercial |
$1,197.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$1,003.25
|
| Rate for Payer: Cash Price |
$855.39
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,185.33
|
| Rate for Payer: Cigna of WY Commercial |
$1,197.55
|
| Rate for Payer: Entrust Commercial |
$1,160.89
|
| Rate for Payer: First Choice Health Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,160.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$806.51
|
| Rate for Payer: HealthUtah PPO |
$1,221.99
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,185.33
|
| Rate for Payer: Multiplan Medicare/VA |
$766.19
|
| Rate for Payer: One Health Plan of WY PPO |
$1,197.55
|
| Rate for Payer: PacificSource Commercial |
$1,099.79
|
| Rate for Payer: PHCS PPO |
$1,197.55
|
| Rate for Payer: Three Rivers PPO |
$916.49
|
| Rate for Payer: TriWest Veterans Administration |
$806.51
|
| Rate for Payer: United Healthcare Commercial |
$1,063.13
|
| Rate for Payer: United Healthcare Medicare |
$806.51
|
| Rate for Payer: WINHealth Partners Commercial |
$1,160.89
|
| Rate for Payer: Wise Provider Network Commercial |
$1,160.89
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [43069]
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
HCPCS J7605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.58
|
| Rate for Payer: Aetna of WY Medicare |
$3.08
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.48
|
| Rate for Payer: Altius Commercial |
$4.48
|
| Rate for Payer: Beech Street Commercial |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.53
|
| Rate for Payer: Cigna of WY Commercial |
$4.58
|
| Rate for Payer: Entrust Commercial |
$4.44
|
| Rate for Payer: First Choice Health Commercial |
$4.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.71
|
| Rate for Payer: HealthUtah PPO |
$4.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.53
|
| Rate for Payer: Multiplan Medicare/VA |
$2.57
|
| Rate for Payer: One Health Plan of WY PPO |
$4.58
|
| Rate for Payer: PacificSource Commercial |
$4.20
|
| Rate for Payer: PHCS PPO |
$4.58
|
| Rate for Payer: Three Rivers PPO |
$3.50
|
| Rate for Payer: TriWest Veterans Administration |
$2.71
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$2.71
|
| Rate for Payer: WINHealth Partners Commercial |
$4.58
|
| Rate for Payer: Wise Provider Network Commercial |
$4.44
|
|
|
ARFORMOTEROL 15 MCG/2 ML SOLUTION FOR NEBULIZATION [43069]
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
HCPCS J7605
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$4.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.58
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.48
|
| Rate for Payer: Altius Commercial |
$4.48
|
| Rate for Payer: Beech Street Commercial |
$4.58
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.83
|
| Rate for Payer: Cash Price |
$3.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.53
|
| Rate for Payer: Cigna of WY Commercial |
$4.58
|
| Rate for Payer: Entrust Commercial |
$4.44
|
| Rate for Payer: First Choice Health Commercial |
$4.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.08
|
| Rate for Payer: HealthUtah PPO |
$4.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.53
|
| Rate for Payer: Multiplan Medicare/VA |
$2.93
|
| Rate for Payer: One Health Plan of WY PPO |
$4.58
|
| Rate for Payer: PacificSource Commercial |
$4.20
|
| Rate for Payer: PHCS PPO |
$4.58
|
| Rate for Payer: Three Rivers PPO |
$3.50
|
| Rate for Payer: TriWest Veterans Administration |
$3.08
|
| Rate for Payer: United Healthcare Commercial |
$4.06
|
| Rate for Payer: United Healthcare Medicare |
$3.08
|
| Rate for Payer: WINHealth Partners Commercial |
$4.44
|
| Rate for Payer: Wise Provider Network Commercial |
$4.44
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [150751]
|
Facility
|
IP
|
$9.44
|
|
|
Service Code
|
NDC 5978166679
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.92 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.06
|
| Rate for Payer: Altius Commercial |
$9.06
|
| Rate for Payer: Beech Street Commercial |
$9.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.16
|
| Rate for Payer: Cigna of WY Commercial |
$9.25
|
| Rate for Payer: Entrust Commercial |
$8.97
|
| Rate for Payer: First Choice Health Commercial |
$8.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.23
|
| Rate for Payer: HealthUtah PPO |
$9.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.16
|
| Rate for Payer: Multiplan Medicare/VA |
$5.92
|
| Rate for Payer: One Health Plan of WY PPO |
$9.25
|
| Rate for Payer: PacificSource Commercial |
$8.50
|
| Rate for Payer: PHCS PPO |
$9.25
|
| Rate for Payer: Three Rivers PPO |
$7.08
|
| Rate for Payer: TriWest Veterans Administration |
$6.23
|
| Rate for Payer: United Healthcare Commercial |
$8.21
|
| Rate for Payer: United Healthcare Medicare |
$6.23
|
| Rate for Payer: WINHealth Partners Commercial |
$8.97
|
| Rate for Payer: Wise Provider Network Commercial |
$8.97
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [150751]
|
Facility
|
IP
|
$9.45
|
|
|
Service Code
|
NDC 5978166678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.93 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.26
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.07
|
| Rate for Payer: Altius Commercial |
$9.07
|
| Rate for Payer: Beech Street Commercial |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.76
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.17
|
| Rate for Payer: Cigna of WY Commercial |
$9.26
|
| Rate for Payer: Entrust Commercial |
$8.98
|
| Rate for Payer: First Choice Health Commercial |
$8.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.24
|
| Rate for Payer: HealthUtah PPO |
$9.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.17
|
| Rate for Payer: Multiplan Medicare/VA |
$5.93
|
| Rate for Payer: One Health Plan of WY PPO |
$9.26
|
| Rate for Payer: PacificSource Commercial |
$8.50
|
| Rate for Payer: PHCS PPO |
$9.26
|
| Rate for Payer: Three Rivers PPO |
$7.09
|
| Rate for Payer: TriWest Veterans Administration |
$6.24
|
| Rate for Payer: United Healthcare Commercial |
$8.22
|
| Rate for Payer: United Healthcare Medicare |
$6.24
|
| Rate for Payer: WINHealth Partners Commercial |
$8.98
|
| Rate for Payer: Wise Provider Network Commercial |
$8.98
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [150751]
|
Facility
|
OP
|
$9.45
|
|
|
Service Code
|
NDC 5978166678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.21 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.26
|
| Rate for Payer: Aetna of WY Medicare |
$6.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.07
|
| Rate for Payer: Altius Commercial |
$9.07
|
| Rate for Payer: Beech Street Commercial |
$9.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.76
|
| Rate for Payer: Cash Price |
$6.62
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.17
|
| Rate for Payer: Cigna of WY Commercial |
$9.26
|
| Rate for Payer: Entrust Commercial |
$8.98
|
| Rate for Payer: First Choice Health Commercial |
$8.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.98
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.48
|
| Rate for Payer: HealthUtah PPO |
$9.45
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.17
|
| Rate for Payer: Multiplan Medicare/VA |
$5.21
|
| Rate for Payer: One Health Plan of WY PPO |
$9.26
|
| Rate for Payer: PacificSource Commercial |
$8.50
|
| Rate for Payer: PHCS PPO |
$9.26
|
| Rate for Payer: Three Rivers PPO |
$7.09
|
| Rate for Payer: TriWest Veterans Administration |
$5.48
|
| Rate for Payer: United Healthcare Commercial |
$8.22
|
| Rate for Payer: United Healthcare Medicare |
$5.48
|
| Rate for Payer: WINHealth Partners Commercial |
$9.26
|
| Rate for Payer: Wise Provider Network Commercial |
$8.98
|
|
|
ARGININE 7 GRAM-GLUTAM 7 GRAM-CAHMB 1.5 GRAM-COLLA-MV-MIN ORAL PWD PKT [150751]
|
Facility
|
OP
|
$9.44
|
|
|
Service Code
|
NDC 5978166679
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$9.44 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$9.25
|
| Rate for Payer: Aetna of WY Medicare |
$6.23
|
| Rate for Payer: Altius Auto/Workers Compensation |
$9.06
|
| Rate for Payer: Altius Commercial |
$9.06
|
| Rate for Payer: Beech Street Commercial |
$9.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$7.75
|
| Rate for Payer: Cash Price |
$6.61
|
| Rate for Payer: ChoiceCare Network Commercial |
$9.16
|
| Rate for Payer: Cigna of WY Commercial |
$9.25
|
| Rate for Payer: Entrust Commercial |
$8.97
|
| Rate for Payer: First Choice Health Commercial |
$8.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$8.97
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$5.48
|
| Rate for Payer: HealthUtah PPO |
$9.44
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$9.16
|
| Rate for Payer: Multiplan Medicare/VA |
$5.20
|
| Rate for Payer: One Health Plan of WY PPO |
$9.25
|
| Rate for Payer: PacificSource Commercial |
$8.50
|
| Rate for Payer: PHCS PPO |
$9.25
|
| Rate for Payer: Three Rivers PPO |
$7.08
|
| Rate for Payer: TriWest Veterans Administration |
$5.48
|
| Rate for Payer: United Healthcare Commercial |
$8.21
|
| Rate for Payer: United Healthcare Medicare |
$5.48
|
| Rate for Payer: WINHealth Partners Commercial |
$9.25
|
| Rate for Payer: Wise Provider Network Commercial |
$8.97
|
|
|
ARGININE-VITAMIN C-VITAMIN E ORAL 4.5 GRAM-156 MG/9.2 GRAM POWDER PKT [137885]
|
Facility
|
IP
|
$4.60
|
|
|
Service Code
|
NDC 4390035980
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.51
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.42
|
| Rate for Payer: Altius Commercial |
$4.42
|
| Rate for Payer: Beech Street Commercial |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.46
|
| Rate for Payer: Cigna of WY Commercial |
$4.51
|
| Rate for Payer: Entrust Commercial |
$4.37
|
| Rate for Payer: First Choice Health Commercial |
$4.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$3.04
|
| Rate for Payer: HealthUtah PPO |
$4.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.46
|
| Rate for Payer: Multiplan Medicare/VA |
$2.88
|
| Rate for Payer: One Health Plan of WY PPO |
$4.51
|
| Rate for Payer: PacificSource Commercial |
$4.14
|
| Rate for Payer: PHCS PPO |
$4.51
|
| Rate for Payer: Three Rivers PPO |
$3.45
|
| Rate for Payer: TriWest Veterans Administration |
$3.04
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicare |
$3.04
|
| Rate for Payer: WINHealth Partners Commercial |
$4.37
|
| Rate for Payer: Wise Provider Network Commercial |
$4.37
|
|
|
ARGININE-VITAMIN C-VITAMIN E ORAL 4.5 GRAM-156 MG/9.2 GRAM POWDER PKT [137885]
|
Facility
|
OP
|
$4.60
|
|
|
Service Code
|
NDC 4390035980
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4.51
|
| Rate for Payer: Aetna of WY Medicare |
$3.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$4.42
|
| Rate for Payer: Altius Commercial |
$4.42
|
| Rate for Payer: Beech Street Commercial |
$4.51
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.78
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: ChoiceCare Network Commercial |
$4.46
|
| Rate for Payer: Cigna of WY Commercial |
$4.51
|
| Rate for Payer: Entrust Commercial |
$4.37
|
| Rate for Payer: First Choice Health Commercial |
$4.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4.37
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.67
|
| Rate for Payer: HealthUtah PPO |
$4.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4.46
|
| Rate for Payer: Multiplan Medicare/VA |
$2.53
|
| Rate for Payer: One Health Plan of WY PPO |
$4.51
|
| Rate for Payer: PacificSource Commercial |
$4.14
|
| Rate for Payer: PHCS PPO |
$4.51
|
| Rate for Payer: Three Rivers PPO |
$3.45
|
| Rate for Payer: TriWest Veterans Administration |
$2.67
|
| Rate for Payer: United Healthcare Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicare |
$2.67
|
| Rate for Payer: WINHealth Partners Commercial |
$4.51
|
| Rate for Payer: Wise Provider Network Commercial |
$4.37
|
|
|
ARGYLE CAROTID ARTERY SHUNT KIT
|
Facility
|
IP
|
$117.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$117.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.21
|
| Rate for Payer: Altius Auto/Workers Compensation |
$112.86
|
| Rate for Payer: Altius Commercial |
$112.86
|
| Rate for Payer: Beech Street Commercial |
$115.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.52
|
| Rate for Payer: Cash Price |
$82.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.03
|
| Rate for Payer: Cigna of WY Commercial |
$115.21
|
| Rate for Payer: Entrust Commercial |
$111.68
|
| Rate for Payer: First Choice Health Commercial |
$111.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.59
|
| Rate for Payer: HealthUtah PPO |
$117.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.03
|
| Rate for Payer: Multiplan Medicare/VA |
$73.71
|
| Rate for Payer: One Health Plan of WY PPO |
$115.21
|
| Rate for Payer: PacificSource Commercial |
$105.80
|
| Rate for Payer: PHCS PPO |
$115.21
|
| Rate for Payer: Three Rivers PPO |
$88.17
|
| Rate for Payer: TriWest Veterans Administration |
$77.59
|
| Rate for Payer: United Healthcare Commercial |
$102.28
|
| Rate for Payer: United Healthcare Medicare |
$77.59
|
| Rate for Payer: WINHealth Partners Commercial |
$111.68
|
| Rate for Payer: Wise Provider Network Commercial |
$111.68
|
|
|
ARGYLE CAROTID ARTERY SHUNT KIT
|
Facility
|
OP
|
$117.56
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$117.56 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$115.21
|
| Rate for Payer: Aetna of WY Medicare |
$77.59
|
| Rate for Payer: Altius Auto/Workers Compensation |
$112.86
|
| Rate for Payer: Altius Commercial |
$112.86
|
| Rate for Payer: Beech Street Commercial |
$115.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$96.52
|
| Rate for Payer: Cash Price |
$82.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$114.03
|
| Rate for Payer: Cigna of WY Commercial |
$115.21
|
| Rate for Payer: Entrust Commercial |
$111.68
|
| Rate for Payer: First Choice Health Commercial |
$111.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$111.68
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.18
|
| Rate for Payer: HealthUtah PPO |
$117.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$114.03
|
| Rate for Payer: Multiplan Medicare/VA |
$64.78
|
| Rate for Payer: One Health Plan of WY PPO |
$115.21
|
| Rate for Payer: PacificSource Commercial |
$105.80
|
| Rate for Payer: PHCS PPO |
$115.21
|
| Rate for Payer: Three Rivers PPO |
$88.17
|
| Rate for Payer: TriWest Veterans Administration |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$102.28
|
| Rate for Payer: United Healthcare Medicare |
$68.18
|
| Rate for Payer: WINHealth Partners Commercial |
$115.21
|
| Rate for Payer: Wise Provider Network Commercial |
$111.68
|
|
|
ARIPIPRAZOLE 5 MG TABLET [29228]
|
Facility
|
OP
|
$0.95
|
|
|
Service Code
|
NDC 6233209831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.93
|
| Rate for Payer: Aetna of WY Medicare |
$0.63
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.91
|
| Rate for Payer: Altius Commercial |
$0.91
|
| Rate for Payer: Beech Street Commercial |
$0.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.92
|
| Rate for Payer: Cigna of WY Commercial |
$0.93
|
| Rate for Payer: Entrust Commercial |
$0.90
|
| Rate for Payer: First Choice Health Commercial |
$0.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.55
|
| Rate for Payer: HealthUtah PPO |
$0.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.92
|
| Rate for Payer: Multiplan Medicare/VA |
$0.52
|
| Rate for Payer: One Health Plan of WY PPO |
$0.93
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.93
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
| Rate for Payer: WINHealth Partners Commercial |
$0.93
|
| Rate for Payer: Wise Provider Network Commercial |
$0.90
|
|
|
ARIPIPRAZOLE 5 MG TABLET [29228]
|
Facility
|
IP
|
$0.95
|
|
|
Service Code
|
NDC 6233209831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.93
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.91
|
| Rate for Payer: Altius Commercial |
$0.91
|
| Rate for Payer: Beech Street Commercial |
$0.93
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.78
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.92
|
| Rate for Payer: Cigna of WY Commercial |
$0.93
|
| Rate for Payer: Entrust Commercial |
$0.90
|
| Rate for Payer: First Choice Health Commercial |
$0.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.63
|
| Rate for Payer: HealthUtah PPO |
$0.95
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.92
|
| Rate for Payer: Multiplan Medicare/VA |
$0.60
|
| Rate for Payer: One Health Plan of WY PPO |
$0.93
|
| Rate for Payer: PacificSource Commercial |
$0.86
|
| Rate for Payer: PHCS PPO |
$0.93
|
| Rate for Payer: Three Rivers PPO |
$0.71
|
| Rate for Payer: TriWest Veterans Administration |
$0.63
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$0.63
|
| Rate for Payer: WINHealth Partners Commercial |
$0.90
|
| Rate for Payer: Wise Provider Network Commercial |
$0.90
|
|
|
ARISTA FLEXITIP APPL 14CM
|
Facility
|
IP
|
$113.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.88 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.53
|
| Rate for Payer: Altius Commercial |
$108.53
|
| Rate for Payer: Beech Street Commercial |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.81
|
| Rate for Payer: Cash Price |
$79.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.66
|
| Rate for Payer: Cigna of WY Commercial |
$110.79
|
| Rate for Payer: Entrust Commercial |
$107.40
|
| Rate for Payer: First Choice Health Commercial |
$107.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$74.61
|
| Rate for Payer: HealthUtah PPO |
$113.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.66
|
| Rate for Payer: Multiplan Medicare/VA |
$70.88
|
| Rate for Payer: One Health Plan of WY PPO |
$110.79
|
| Rate for Payer: PacificSource Commercial |
$101.74
|
| Rate for Payer: PHCS PPO |
$110.79
|
| Rate for Payer: Three Rivers PPO |
$84.79
|
| Rate for Payer: TriWest Veterans Administration |
$74.61
|
| Rate for Payer: United Healthcare Commercial |
$98.35
|
| Rate for Payer: United Healthcare Medicare |
$74.61
|
| Rate for Payer: WINHealth Partners Commercial |
$107.40
|
| Rate for Payer: Wise Provider Network Commercial |
$107.40
|
|
|
ARISTA FLEXITIP APPL 14CM
|
Facility
|
OP
|
$113.05
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.29 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$110.79
|
| Rate for Payer: Aetna of WY Medicare |
$74.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$108.53
|
| Rate for Payer: Altius Commercial |
$108.53
|
| Rate for Payer: Beech Street Commercial |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$92.81
|
| Rate for Payer: Cash Price |
$79.13
|
| Rate for Payer: ChoiceCare Network Commercial |
$109.66
|
| Rate for Payer: Cigna of WY Commercial |
$110.79
|
| Rate for Payer: Entrust Commercial |
$107.40
|
| Rate for Payer: First Choice Health Commercial |
$107.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$107.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.57
|
| Rate for Payer: HealthUtah PPO |
$113.05
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$109.66
|
| Rate for Payer: Multiplan Medicare/VA |
$62.29
|
| Rate for Payer: One Health Plan of WY PPO |
$110.79
|
| Rate for Payer: PacificSource Commercial |
$101.74
|
| Rate for Payer: PHCS PPO |
$110.79
|
| Rate for Payer: Three Rivers PPO |
$84.79
|
| Rate for Payer: TriWest Veterans Administration |
$65.57
|
| Rate for Payer: United Healthcare Commercial |
$98.35
|
| Rate for Payer: United Healthcare Medicare |
$65.57
|
| Rate for Payer: WINHealth Partners Commercial |
$110.79
|
| Rate for Payer: Wise Provider Network Commercial |
$107.40
|
|
|
ARISTA-USA 3GM
|
Facility
|
OP
|
$735.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$405.18 |
| Max. Negotiated Rate |
$735.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.64
|
| Rate for Payer: Aetna of WY Medicare |
$485.33
|
| Rate for Payer: Altius Auto/Workers Compensation |
$705.94
|
| Rate for Payer: Altius Commercial |
$705.94
|
| Rate for Payer: Beech Street Commercial |
$720.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$603.72
|
| Rate for Payer: Cash Price |
$514.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.29
|
| Rate for Payer: Cigna of WY Commercial |
$720.64
|
| Rate for Payer: Entrust Commercial |
$698.58
|
| Rate for Payer: First Choice Health Commercial |
$698.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$426.50
|
| Rate for Payer: HealthUtah PPO |
$735.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.29
|
| Rate for Payer: Multiplan Medicare/VA |
$405.18
|
| Rate for Payer: One Health Plan of WY PPO |
$720.64
|
| Rate for Payer: PacificSource Commercial |
$661.82
|
| Rate for Payer: PHCS PPO |
$720.64
|
| Rate for Payer: Three Rivers PPO |
$551.51
|
| Rate for Payer: TriWest Veterans Administration |
$426.50
|
| Rate for Payer: United Healthcare Commercial |
$639.75
|
| Rate for Payer: United Healthcare Medicare |
$426.50
|
| Rate for Payer: WINHealth Partners Commercial |
$720.64
|
| Rate for Payer: Wise Provider Network Commercial |
$698.58
|
|
|
ARISTA-USA 3GM
|
Facility
|
IP
|
$735.35
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.06 |
| Max. Negotiated Rate |
$735.35 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$720.64
|
| Rate for Payer: Altius Auto/Workers Compensation |
$705.94
|
| Rate for Payer: Altius Commercial |
$705.94
|
| Rate for Payer: Beech Street Commercial |
$720.64
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$603.72
|
| Rate for Payer: Cash Price |
$514.74
|
| Rate for Payer: ChoiceCare Network Commercial |
$713.29
|
| Rate for Payer: Cigna of WY Commercial |
$720.64
|
| Rate for Payer: Entrust Commercial |
$698.58
|
| Rate for Payer: First Choice Health Commercial |
$698.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$698.58
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$485.33
|
| Rate for Payer: HealthUtah PPO |
$735.35
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$713.29
|
| Rate for Payer: Multiplan Medicare/VA |
$461.06
|
| Rate for Payer: One Health Plan of WY PPO |
$720.64
|
| Rate for Payer: PacificSource Commercial |
$661.82
|
| Rate for Payer: PHCS PPO |
$720.64
|
| Rate for Payer: Three Rivers PPO |
$551.51
|
| Rate for Payer: TriWest Veterans Administration |
$485.33
|
| Rate for Payer: United Healthcare Commercial |
$639.75
|
| Rate for Payer: United Healthcare Medicare |
$485.33
|
| Rate for Payer: WINHealth Partners Commercial |
$698.58
|
| Rate for Payer: Wise Provider Network Commercial |
$698.58
|
|
|
ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA
|
Professional
|
Both
|
$6,926.00
|
|
|
Service Code
|
HCPCS 27485 50
|
| Hospital Charge Code |
27485
|
| Min. Negotiated Rate |
$555.87 |
| Max. Negotiated Rate |
$6,926.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,787.48
|
| Rate for Payer: Aetna of WY Medicare |
$653.96
|
| Rate for Payer: Beech Street Commercial |
$6,579.70
|
| Rate for Payer: Cash Price |
$4,848.20
|
| Rate for Payer: Cash Price |
$4,848.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,718.22
|
| Rate for Payer: Cigna of WY Commercial |
$6,787.48
|
| Rate for Payer: First Choice Health Commercial |
$6,233.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$6,579.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$653.96
|
| Rate for Payer: HealthUtah PPO |
$6,926.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,718.22
|
| Rate for Payer: Multiplan Medicare/VA |
$555.87
|
| Rate for Payer: One Health Plan of WY PPO |
$6,787.48
|
| Rate for Payer: PacificSource Commercial |
$6,233.40
|
| Rate for Payer: PHCS PPO |
$6,579.70
|
| Rate for Payer: Three Rivers PPO |
$5,194.50
|
| Rate for Payer: TriWest Veterans Administration |
$653.96
|
| Rate for Payer: United Healthcare Commercial |
$6,025.62
|
| Rate for Payer: United Healthcare Medicare |
$653.96
|
| Rate for Payer: WINHealth Partners Commercial |
$5,887.10
|
|
|
ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA
|
Professional
|
Both
|
$3,463.00
|
|
|
Service Code
|
HCPCS 27485
|
| Hospital Charge Code |
27485
|
| Min. Negotiated Rate |
$555.87 |
| 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 |
$653.96
|
| 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 |
$653.96
|
| Rate for Payer: HealthUtah PPO |
$3,463.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,359.11
|
| Rate for Payer: Multiplan Medicare/VA |
$555.87
|
| 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 |
$653.96
|
| Rate for Payer: United Healthcare Commercial |
$3,012.81
|
| Rate for Payer: United Healthcare Medicare |
$653.96
|
| Rate for Payer: WINHealth Partners Commercial |
$2,943.55
|
|
|
ARTERIAL FEMORAL CATH KIT 18G
|
Facility
|
OP
|
$378.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.66 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.13
|
| Rate for Payer: Aetna of WY Medicare |
$249.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$363.55
|
| Rate for Payer: Altius Commercial |
$363.55
|
| Rate for Payer: Beech Street Commercial |
$371.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.91
|
| Rate for Payer: Cash Price |
$265.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.34
|
| Rate for Payer: Cigna of WY Commercial |
$371.13
|
| Rate for Payer: Entrust Commercial |
$359.76
|
| Rate for Payer: First Choice Health Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$219.65
|
| Rate for Payer: HealthUtah PPO |
$378.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.34
|
| Rate for Payer: Multiplan Medicare/VA |
$208.66
|
| Rate for Payer: One Health Plan of WY PPO |
$371.13
|
| Rate for Payer: PacificSource Commercial |
$340.83
|
| Rate for Payer: PHCS PPO |
$371.13
|
| Rate for Payer: Three Rivers PPO |
$284.02
|
| Rate for Payer: TriWest Veterans Administration |
$219.65
|
| Rate for Payer: United Healthcare Commercial |
$329.47
|
| Rate for Payer: United Healthcare Medicare |
$219.65
|
| Rate for Payer: WINHealth Partners Commercial |
$371.13
|
| Rate for Payer: Wise Provider Network Commercial |
$359.76
|
|
|
ARTERIAL FEMORAL CATH KIT 18G
|
Facility
|
IP
|
$378.70
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.44 |
| Max. Negotiated Rate |
$378.70 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$371.13
|
| Rate for Payer: Altius Auto/Workers Compensation |
$363.55
|
| Rate for Payer: Altius Commercial |
$363.55
|
| Rate for Payer: Beech Street Commercial |
$371.13
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$310.91
|
| Rate for Payer: Cash Price |
$265.09
|
| Rate for Payer: ChoiceCare Network Commercial |
$367.34
|
| Rate for Payer: Cigna of WY Commercial |
$371.13
|
| Rate for Payer: Entrust Commercial |
$359.76
|
| Rate for Payer: First Choice Health Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$359.76
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$249.94
|
| Rate for Payer: HealthUtah PPO |
$378.70
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$367.34
|
| Rate for Payer: Multiplan Medicare/VA |
$237.44
|
| Rate for Payer: One Health Plan of WY PPO |
$371.13
|
| Rate for Payer: PacificSource Commercial |
$340.83
|
| Rate for Payer: PHCS PPO |
$371.13
|
| Rate for Payer: Three Rivers PPO |
$284.02
|
| Rate for Payer: TriWest Veterans Administration |
$249.94
|
| Rate for Payer: United Healthcare Commercial |
$329.47
|
| Rate for Payer: United Healthcare Medicare |
$249.94
|
| Rate for Payer: WINHealth Partners Commercial |
$359.76
|
| Rate for Payer: Wise Provider Network Commercial |
$359.76
|
|
|
ARTERIAL WRIST SUPPORT ANES
|
Facility
|
IP
|
$13.11
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.85
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.59
|
| Rate for Payer: Altius Commercial |
$12.59
|
| Rate for Payer: Beech Street Commercial |
$12.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.72
|
| Rate for Payer: Cigna of WY Commercial |
$12.85
|
| Rate for Payer: Entrust Commercial |
$12.45
|
| Rate for Payer: First Choice Health Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.65
|
| Rate for Payer: HealthUtah PPO |
$13.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.72
|
| Rate for Payer: Multiplan Medicare/VA |
$8.22
|
| Rate for Payer: One Health Plan of WY PPO |
$12.85
|
| Rate for Payer: PacificSource Commercial |
$11.80
|
| Rate for Payer: PHCS PPO |
$12.85
|
| Rate for Payer: Three Rivers PPO |
$9.83
|
| Rate for Payer: TriWest Veterans Administration |
$8.65
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$8.65
|
| Rate for Payer: WINHealth Partners Commercial |
$12.45
|
| Rate for Payer: Wise Provider Network Commercial |
$12.45
|
|
|
ARTERIAL WRIST SUPPORT ANES
|
Facility
|
OP
|
$13.11
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.22 |
| Max. Negotiated Rate |
$13.11 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$12.85
|
| Rate for Payer: Aetna of WY Medicare |
$8.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$12.59
|
| Rate for Payer: Altius Commercial |
$12.59
|
| Rate for Payer: Beech Street Commercial |
$12.85
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.76
|
| Rate for Payer: Cash Price |
$9.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$12.72
|
| Rate for Payer: Cigna of WY Commercial |
$12.85
|
| Rate for Payer: Entrust Commercial |
$12.45
|
| Rate for Payer: First Choice Health Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$12.45
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.60
|
| Rate for Payer: HealthUtah PPO |
$13.11
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$12.72
|
| Rate for Payer: Multiplan Medicare/VA |
$7.22
|
| Rate for Payer: One Health Plan of WY PPO |
$12.85
|
| Rate for Payer: PacificSource Commercial |
$11.80
|
| Rate for Payer: PHCS PPO |
$12.85
|
| Rate for Payer: Three Rivers PPO |
$9.83
|
| Rate for Payer: TriWest Veterans Administration |
$7.60
|
| Rate for Payer: United Healthcare Commercial |
$11.41
|
| Rate for Payer: United Healthcare Medicare |
$7.60
|
| Rate for Payer: WINHealth Partners Commercial |
$12.85
|
| Rate for Payer: Wise Provider Network Commercial |
$12.45
|
|
|
ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 36821
|
| Hospital Charge Code |
36821
|
| Min. Negotiated Rate |
$518.39 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,132.48
|
| Rate for Payer: Aetna of WY Medicare |
$609.87
|
| Rate for Payer: Beech Street Commercial |
$2,067.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,110.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,132.48
|
| Rate for Payer: First Choice Health Commercial |
$1,958.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,067.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.87
|
| Rate for Payer: HealthUtah PPO |
$2,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,110.72
|
| Rate for Payer: Multiplan Medicare/VA |
$518.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,132.48
|
| Rate for Payer: PacificSource Commercial |
$1,958.40
|
| Rate for Payer: PHCS PPO |
$2,067.20
|
| Rate for Payer: Three Rivers PPO |
$1,632.00
|
| Rate for Payer: TriWest Veterans Administration |
$609.87
|
| Rate for Payer: United Healthcare Commercial |
$1,893.12
|
| Rate for Payer: United Healthcare Medicare |
$609.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,849.60
|
|
|
ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT
|
Professional
|
Both
|
$2,176.00
|
|
|
Service Code
|
HCPCS 36821 AS
|
| Hospital Charge Code |
36821
|
| Min. Negotiated Rate |
$518.39 |
| Max. Negotiated Rate |
$2,176.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,132.48
|
| Rate for Payer: Aetna of WY Medicare |
$609.87
|
| Rate for Payer: Beech Street Commercial |
$2,067.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: Cash Price |
$1,523.20
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,110.72
|
| Rate for Payer: Cigna of WY Commercial |
$2,132.48
|
| Rate for Payer: First Choice Health Commercial |
$1,958.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,067.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$609.87
|
| Rate for Payer: HealthUtah PPO |
$2,176.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,110.72
|
| Rate for Payer: Multiplan Medicare/VA |
$518.39
|
| Rate for Payer: One Health Plan of WY PPO |
$2,132.48
|
| Rate for Payer: PacificSource Commercial |
$1,958.40
|
| Rate for Payer: PHCS PPO |
$2,067.20
|
| Rate for Payer: Three Rivers PPO |
$1,632.00
|
| Rate for Payer: TriWest Veterans Administration |
$609.87
|
| Rate for Payer: United Healthcare Commercial |
$1,893.12
|
| Rate for Payer: United Healthcare Medicare |
$609.87
|
| Rate for Payer: WINHealth Partners Commercial |
$1,849.60
|
|
