|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [23879]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.00
|
| Rate for Payer: Aetna of WY Medicare |
$25.34
|
| Rate for Payer: Aetna of WY Medicare |
$28.74
|
| Rate for Payer: Aetna of WY Medicare |
$36.00
|
| Rate for Payer: Altius Commercial |
$38.01
|
| Rate for Payer: Altius Commercial |
$43.10
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$38.80
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$44.00
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.55
|
| Rate for Payer: Cash Price |
$27.71
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$38.80
|
| Rate for Payer: Cigna of WY Commercial |
$44.00
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$37.61
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$42.66
|
| Rate for Payer: First Choice Health Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.31
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$27.39
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$24.15
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$44.90
|
| Rate for Payer: HealthUtah PPO |
$39.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.40
|
| Rate for Payer: Multiplan Medicare/VA |
$26.02
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: Multiplan Medicare/VA |
$22.94
|
| Rate for Payer: One Health Plan of WY PPO |
$44.00
|
| Rate for Payer: One Health Plan of WY PPO |
$38.80
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PacificSource Commercial |
$35.63
|
| Rate for Payer: PacificSource Commercial |
$40.41
|
| Rate for Payer: PHCS PPO |
$44.00
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: PHCS PPO |
$38.80
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: Three Rivers PPO |
$29.69
|
| Rate for Payer: Three Rivers PPO |
$33.68
|
| Rate for Payer: TriWest Veterans Administration |
$27.39
|
| Rate for Payer: TriWest Veterans Administration |
$34.31
|
| Rate for Payer: TriWest Veterans Administration |
$24.15
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Commercial |
$42.88
|
| Rate for Payer: United Healthcare Commercial |
$37.81
|
| Rate for Payer: United Healthcare Medicare |
$27.39
|
| Rate for Payer: United Healthcare Medicare |
$24.15
|
| Rate for Payer: United Healthcare Medicare |
$34.31
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: WINHealth Partners Commercial |
$42.66
|
| Rate for Payer: WINHealth Partners Commercial |
$37.61
|
| Rate for Payer: Wise Provider Network Commercial |
$42.66
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$37.61
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYRINGE [23879]
|
Facility
|
OP
|
$39.59
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.44 |
| Max. Negotiated Rate |
$39.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.80
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$44.00
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Aetna of WY Medicare |
$26.13
|
| Rate for Payer: Aetna of WY Medicare |
$29.63
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Altius Commercial |
$38.01
|
| Rate for Payer: Altius Commercial |
$43.10
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$44.00
|
| Rate for Payer: Beech Street Commercial |
$38.80
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$43.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cash Price |
$27.71
|
| Rate for Payer: ChoiceCare Network Commercial |
$38.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$43.55
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$44.00
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$38.80
|
| Rate for Payer: Entrust Commercial |
$42.66
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: Entrust Commercial |
$37.61
|
| Rate for Payer: First Choice Health Commercial |
$37.61
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$42.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.61
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$42.66
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.06
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.59
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.57
|
| Rate for Payer: HealthUtah PPO |
$44.90
|
| Rate for Payer: HealthUtah PPO |
$39.59
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$43.55
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$38.40
|
| Rate for Payer: Multiplan Medicare/VA |
$21.44
|
| Rate for Payer: Multiplan Medicare/VA |
$24.31
|
| Rate for Payer: Multiplan Medicare/VA |
$30.46
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$44.00
|
| Rate for Payer: One Health Plan of WY PPO |
$38.80
|
| Rate for Payer: PacificSource Commercial |
$35.63
|
| Rate for Payer: PacificSource Commercial |
$40.41
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$38.80
|
| Rate for Payer: PHCS PPO |
$44.00
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: Three Rivers PPO |
$33.68
|
| Rate for Payer: Three Rivers PPO |
$29.69
|
| Rate for Payer: TriWest Veterans Administration |
$22.57
|
| Rate for Payer: TriWest Veterans Administration |
$25.59
|
| Rate for Payer: TriWest Veterans Administration |
$32.06
|
| Rate for Payer: United Healthcare Commercial |
$37.81
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Commercial |
$42.88
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$25.59
|
| Rate for Payer: United Healthcare Medicare |
$22.57
|
| Rate for Payer: WINHealth Partners Commercial |
$44.00
|
| Rate for Payer: WINHealth Partners Commercial |
$38.80
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$37.61
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$42.66
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [23876]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.21
|
| Rate for Payer: Aetna of WY Medicare |
$36.00
|
| Rate for Payer: Aetna of WY Medicare |
$28.22
|
| Rate for Payer: Altius Commercial |
$42.33
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$43.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.77
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.77
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Cigna of WY Commercial |
$43.21
|
| Rate for Payer: Entrust Commercial |
$41.89
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$41.89
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$34.31
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$44.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.77
|
| Rate for Payer: Multiplan Medicare/VA |
$25.55
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| Rate for Payer: One Health Plan of WY PPO |
$43.21
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: PacificSource Commercial |
$39.68
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: PHCS PPO |
$43.21
|
| Rate for Payer: Three Rivers PPO |
$33.07
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: TriWest Veterans Administration |
$34.31
|
| Rate for Payer: TriWest Veterans Administration |
$26.89
|
| Rate for Payer: United Healthcare Commercial |
$42.11
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$26.89
|
| Rate for Payer: United Healthcare Medicare |
$34.31
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: WINHealth Partners Commercial |
$41.89
|
| Rate for Payer: Wise Provider Network Commercial |
$41.89
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYRINGE [23876]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$43.21
|
| Rate for Payer: Aetna of WY Medicare |
$29.10
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| Rate for Payer: Altius Commercial |
$42.33
|
| Rate for Payer: Altius Commercial |
$54.00
|
| Rate for Payer: Beech Street Commercial |
$55.12
|
| Rate for Payer: Beech Street Commercial |
$43.21
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$42.77
|
| Rate for Payer: Cash Price |
$39.38
|
| Rate for Payer: Cash Price |
$30.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$42.77
|
| Rate for Payer: ChoiceCare Network Commercial |
$54.56
|
| Rate for Payer: Cigna of WY Commercial |
$43.21
|
| Rate for Payer: Cigna of WY Commercial |
$55.12
|
| Rate for Payer: Entrust Commercial |
$41.89
|
| Rate for Payer: Entrust Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$53.44
|
| Rate for Payer: First Choice Health Commercial |
$41.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$53.44
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$41.89
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.13
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$32.06
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: HealthUtah PPO |
$44.09
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$42.77
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.46
|
| Rate for Payer: Multiplan Medicare/VA |
$23.87
|
| Rate for Payer: One Health Plan of WY PPO |
$55.12
|
| Rate for Payer: One Health Plan of WY PPO |
$43.21
|
| Rate for Payer: PacificSource Commercial |
$39.68
|
| Rate for Payer: PacificSource Commercial |
$50.62
|
| Rate for Payer: PHCS PPO |
$55.12
|
| Rate for Payer: PHCS PPO |
$43.21
|
| Rate for Payer: Three Rivers PPO |
$42.19
|
| Rate for Payer: Three Rivers PPO |
$33.07
|
| Rate for Payer: TriWest Veterans Administration |
$25.13
|
| Rate for Payer: TriWest Veterans Administration |
$32.06
|
| Rate for Payer: United Healthcare Commercial |
$42.11
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
| Rate for Payer: United Healthcare Medicare |
$25.13
|
| Rate for Payer: WINHealth Partners Commercial |
$43.21
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$41.89
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [23877]
|
Facility
|
IP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$36.00
|
| 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 |
$54.56
|
| 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 |
$34.31
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$32.60
|
| 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 |
$34.31
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$34.31
|
| Rate for Payer: WINHealth Partners Commercial |
$53.44
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYRINGE [23877]
|
Facility
|
OP
|
$56.25
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$55.12
|
| Rate for Payer: Aetna of WY Medicare |
$37.12
|
| 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 |
$54.56
|
| 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 |
$32.06
|
| Rate for Payer: HealthUtah PPO |
$56.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$54.56
|
| Rate for Payer: Multiplan Medicare/VA |
$30.46
|
| 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 |
$32.06
|
| Rate for Payer: United Healthcare Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare |
$32.06
|
| Rate for Payer: WINHealth Partners Commercial |
$55.12
|
| Rate for Payer: Wise Provider Network Commercial |
$53.44
|
|
|
ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA
|
Professional
|
Both
|
$2,689.00
|
|
|
Service Code
|
HCPCS 44121
|
| Min. Negotiated Rate |
$191.23 |
| Max. Negotiated Rate |
$2,689.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,635.22
|
| Rate for Payer: Aetna of WY Medicare |
$224.98
|
| Rate for Payer: Beech Street Commercial |
$2,554.55
|
| Rate for Payer: Cash Price |
$1,882.30
|
| Rate for Payer: Cash Price |
$1,882.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,608.33
|
| Rate for Payer: Cigna of WY Commercial |
$2,635.22
|
| Rate for Payer: First Choice Health Commercial |
$2,420.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,554.55
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.98
|
| Rate for Payer: HealthUtah PPO |
$2,689.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,608.33
|
| Rate for Payer: Multiplan Medicare/VA |
$191.23
|
| Rate for Payer: One Health Plan of WY PPO |
$2,635.22
|
| Rate for Payer: PacificSource Commercial |
$2,420.10
|
| Rate for Payer: PHCS PPO |
$2,554.55
|
| Rate for Payer: Three Rivers PPO |
$2,016.75
|
| Rate for Payer: TriWest Veterans Administration |
$224.98
|
| Rate for Payer: United Healthcare Commercial |
$2,554.55
|
| Rate for Payer: WINHealth Partners Commercial |
$2,285.65
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$4,839.00
|
|
|
Service Code
|
HCPCS 44005 80
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$4,839.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,742.22
|
| Rate for Payer: Beech Street Commercial |
$4,597.05
|
| Rate for Payer: Cash Price |
$3,387.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,693.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,742.22
|
| Rate for Payer: First Choice Health Commercial |
$4,355.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,597.05
|
| Rate for Payer: HealthUtah PPO |
$4,839.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,693.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4,742.22
|
| Rate for Payer: PacificSource Commercial |
$4,355.10
|
| Rate for Payer: PHCS PPO |
$4,597.05
|
| Rate for Payer: Three Rivers PPO |
$3,629.25
|
| Rate for Payer: United Healthcare Commercial |
$4,597.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4,113.15
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$4,839.00
|
|
|
Service Code
|
HCPCS 44005
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$4,839.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,742.22
|
| Rate for Payer: Aetna of WY Medicare |
$1,032.78
|
| Rate for Payer: Beech Street Commercial |
$4,597.05
|
| Rate for Payer: Cash Price |
$3,387.30
|
| Rate for Payer: Cash Price |
$3,387.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,693.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,742.22
|
| Rate for Payer: First Choice Health Commercial |
$4,355.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,597.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,032.78
|
| Rate for Payer: HealthUtah PPO |
$4,839.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,693.83
|
| Rate for Payer: Multiplan Medicare/VA |
$877.86
|
| Rate for Payer: One Health Plan of WY PPO |
$4,742.22
|
| Rate for Payer: PacificSource Commercial |
$4,355.10
|
| Rate for Payer: PHCS PPO |
$4,597.05
|
| Rate for Payer: Three Rivers PPO |
$3,629.25
|
| Rate for Payer: TriWest Veterans Administration |
$1,032.78
|
| Rate for Payer: United Healthcare Commercial |
$4,597.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4,113.15
|
|
|
ENTEROLSS FRING INTSTINAL ADHESION SPX
|
Professional
|
Both
|
$4,839.00
|
|
|
Service Code
|
HCPCS 44005 AS
|
| Min. Negotiated Rate |
$877.86 |
| Max. Negotiated Rate |
$4,839.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,742.22
|
| Rate for Payer: Beech Street Commercial |
$4,597.05
|
| Rate for Payer: Cash Price |
$3,387.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,693.83
|
| Rate for Payer: Cigna of WY Commercial |
$4,742.22
|
| Rate for Payer: First Choice Health Commercial |
$4,355.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,597.05
|
| Rate for Payer: HealthUtah PPO |
$4,839.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,693.83
|
| Rate for Payer: One Health Plan of WY PPO |
$4,742.22
|
| Rate for Payer: PacificSource Commercial |
$4,355.10
|
| Rate for Payer: PHCS PPO |
$4,597.05
|
| Rate for Payer: Three Rivers PPO |
$3,629.25
|
| Rate for Payer: United Healthcare Commercial |
$4,597.05
|
| Rate for Payer: WINHealth Partners Commercial |
$4,113.15
|
|
|
ENTERORRHAPHY MULTIPLE PERFORATIONS
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
HCPCS 44603
|
| Min. Negotiated Rate |
$1,296.26 |
| Max. Negotiated Rate |
$2,812.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,755.76
|
| Rate for Payer: Aetna of WY Medicare |
$1,525.01
|
| Rate for Payer: Beech Street Commercial |
$2,671.40
|
| Rate for Payer: Cash Price |
$1,968.40
|
| Rate for Payer: Cash Price |
$1,968.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,727.64
|
| Rate for Payer: Cigna of WY Commercial |
$2,755.76
|
| Rate for Payer: First Choice Health Commercial |
$2,530.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,671.40
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,525.01
|
| Rate for Payer: HealthUtah PPO |
$2,812.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,727.64
|
| Rate for Payer: Multiplan Medicare/VA |
$1,296.26
|
| Rate for Payer: One Health Plan of WY PPO |
$2,755.76
|
| Rate for Payer: PacificSource Commercial |
$2,530.80
|
| Rate for Payer: PHCS PPO |
$2,671.40
|
| Rate for Payer: Three Rivers PPO |
$2,109.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,525.01
|
| Rate for Payer: United Healthcare Commercial |
$2,671.40
|
| Rate for Payer: WINHealth Partners Commercial |
$2,390.20
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$6,240.00
|
|
|
Service Code
|
HCPCS 44602
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$6,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,115.20
|
| Rate for Payer: Aetna of WY Medicare |
$1,324.65
|
| Rate for Payer: Beech Street Commercial |
$5,928.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,052.80
|
| Rate for Payer: Cigna of WY Commercial |
$6,115.20
|
| Rate for Payer: First Choice Health Commercial |
$5,616.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,928.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,324.65
|
| Rate for Payer: HealthUtah PPO |
$6,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,052.80
|
| Rate for Payer: Multiplan Medicare/VA |
$1,125.95
|
| Rate for Payer: One Health Plan of WY PPO |
$6,115.20
|
| Rate for Payer: PacificSource Commercial |
$5,616.00
|
| Rate for Payer: PHCS PPO |
$5,928.00
|
| Rate for Payer: Three Rivers PPO |
$4,680.00
|
| Rate for Payer: TriWest Veterans Administration |
$1,324.65
|
| Rate for Payer: United Healthcare Commercial |
$5,928.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,304.00
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$6,240.00
|
|
|
Service Code
|
HCPCS 44602 AS
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$6,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,115.20
|
| Rate for Payer: Beech Street Commercial |
$5,928.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,052.80
|
| Rate for Payer: Cigna of WY Commercial |
$6,115.20
|
| Rate for Payer: First Choice Health Commercial |
$5,616.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,928.00
|
| Rate for Payer: HealthUtah PPO |
$6,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,052.80
|
| Rate for Payer: One Health Plan of WY PPO |
$6,115.20
|
| Rate for Payer: PacificSource Commercial |
$5,616.00
|
| Rate for Payer: PHCS PPO |
$5,928.00
|
| Rate for Payer: Three Rivers PPO |
$4,680.00
|
| Rate for Payer: United Healthcare Commercial |
$5,928.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,304.00
|
|
|
ENTERORRHAPHY SINGLE PERFORATION
|
Professional
|
Both
|
$6,240.00
|
|
|
Service Code
|
HCPCS 44602 80
|
| Min. Negotiated Rate |
$1,125.95 |
| Max. Negotiated Rate |
$6,240.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$6,115.20
|
| Rate for Payer: Beech Street Commercial |
$5,928.00
|
| Rate for Payer: Cash Price |
$4,368.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$6,052.80
|
| Rate for Payer: Cigna of WY Commercial |
$6,115.20
|
| Rate for Payer: First Choice Health Commercial |
$5,616.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,928.00
|
| Rate for Payer: HealthUtah PPO |
$6,240.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$6,052.80
|
| Rate for Payer: One Health Plan of WY PPO |
$6,115.20
|
| Rate for Payer: PacificSource Commercial |
$5,616.00
|
| Rate for Payer: PHCS PPO |
$5,928.00
|
| Rate for Payer: Three Rivers PPO |
$4,680.00
|
| Rate for Payer: United Healthcare Commercial |
$5,928.00
|
| Rate for Payer: WINHealth Partners Commercial |
$5,304.00
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$5,413.00
|
|
|
Service Code
|
HCPCS 44120
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$5,413.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,304.74
|
| Rate for Payer: Aetna of WY Medicare |
$1,154.87
|
| Rate for Payer: Beech Street Commercial |
$5,142.35
|
| Rate for Payer: Cash Price |
$3,789.10
|
| Rate for Payer: Cash Price |
$3,789.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,250.61
|
| Rate for Payer: Cigna of WY Commercial |
$5,304.74
|
| Rate for Payer: First Choice Health Commercial |
$4,871.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,142.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1,154.87
|
| Rate for Payer: HealthUtah PPO |
$5,413.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,250.61
|
| Rate for Payer: Multiplan Medicare/VA |
$981.64
|
| Rate for Payer: One Health Plan of WY PPO |
$5,304.74
|
| Rate for Payer: PacificSource Commercial |
$4,871.70
|
| Rate for Payer: PHCS PPO |
$5,142.35
|
| Rate for Payer: Three Rivers PPO |
$4,059.75
|
| Rate for Payer: TriWest Veterans Administration |
$1,154.87
|
| Rate for Payer: United Healthcare Commercial |
$5,142.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4,601.05
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$5,413.00
|
|
|
Service Code
|
HCPCS 44120 AS
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$5,413.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,304.74
|
| Rate for Payer: Beech Street Commercial |
$5,142.35
|
| Rate for Payer: Cash Price |
$3,789.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,250.61
|
| Rate for Payer: Cigna of WY Commercial |
$5,304.74
|
| Rate for Payer: First Choice Health Commercial |
$4,871.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,142.35
|
| Rate for Payer: HealthUtah PPO |
$5,413.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,250.61
|
| Rate for Payer: One Health Plan of WY PPO |
$5,304.74
|
| Rate for Payer: PacificSource Commercial |
$4,871.70
|
| Rate for Payer: PHCS PPO |
$5,142.35
|
| Rate for Payer: Three Rivers PPO |
$4,059.75
|
| Rate for Payer: United Healthcare Commercial |
$5,142.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4,601.05
|
|
|
ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST
|
Professional
|
Both
|
$5,413.00
|
|
|
Service Code
|
HCPCS 44120 80
|
| Min. Negotiated Rate |
$981.64 |
| Max. Negotiated Rate |
$5,413.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$5,304.74
|
| Rate for Payer: Beech Street Commercial |
$5,142.35
|
| Rate for Payer: Cash Price |
$3,789.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$5,250.61
|
| Rate for Payer: Cigna of WY Commercial |
$5,304.74
|
| Rate for Payer: First Choice Health Commercial |
$4,871.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$5,142.35
|
| Rate for Payer: HealthUtah PPO |
$5,413.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$5,250.61
|
| Rate for Payer: One Health Plan of WY PPO |
$5,304.74
|
| Rate for Payer: PacificSource Commercial |
$4,871.70
|
| Rate for Payer: PHCS PPO |
$5,142.35
|
| Rate for Payer: Three Rivers PPO |
$4,059.75
|
| Rate for Payer: United Healthcare Commercial |
$5,142.35
|
| Rate for Payer: WINHealth Partners Commercial |
$4,601.05
|
|
|
EO ADJ JT PREFAB CUSTOM FIT
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS L3760
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$201.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$196.98
|
| Rate for Payer: Beech Street Commercial |
$190.95
|
| Rate for Payer: Cash Price |
$140.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$194.97
|
| Rate for Payer: Cigna of WY Commercial |
$196.98
|
| Rate for Payer: First Choice Health Commercial |
$180.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$190.95
|
| Rate for Payer: HealthUtah PPO |
$201.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$194.97
|
| Rate for Payer: One Health Plan of WY PPO |
$196.98
|
| Rate for Payer: PacificSource Commercial |
$180.90
|
| Rate for Payer: PHCS PPO |
$190.95
|
| Rate for Payer: Three Rivers PPO |
$150.75
|
| Rate for Payer: United Healthcare Commercial |
$190.95
|
| Rate for Payer: WINHealth Partners Commercial |
$190.95
|
|
|
EO W/O JOINTS CF
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
HCPCS L3702
|
| Min. Negotiated Rate |
$275.25 |
| Max. Negotiated Rate |
$367.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$359.66
|
| Rate for Payer: Beech Street Commercial |
$348.65
|
| Rate for Payer: Cash Price |
$256.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$355.99
|
| Rate for Payer: Cigna of WY Commercial |
$359.66
|
| Rate for Payer: First Choice Health Commercial |
$330.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$348.65
|
| Rate for Payer: HealthUtah PPO |
$367.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$355.99
|
| Rate for Payer: One Health Plan of WY PPO |
$359.66
|
| Rate for Payer: PacificSource Commercial |
$330.30
|
| Rate for Payer: PHCS PPO |
$348.65
|
| Rate for Payer: Three Rivers PPO |
$275.25
|
| Rate for Payer: United Healthcare Commercial |
$348.65
|
| Rate for Payer: WINHealth Partners Commercial |
$348.65
|
|
|
EPHEDRINE SULFATE 50 MG/ML INTRAVENOUS SOLUTION [145503]
|
Facility
|
IP
|
$73.08
|
|
|
Service Code
|
NDC 4202321625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.35 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Aetna of WY Medicare |
$46.77
|
| 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 |
$70.89
|
| 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 |
$44.58
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$42.35
|
| 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 |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$69.79
|
| Rate for Payer: United Healthcare Medicare |
$44.58
|
| 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 4202321601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.57 |
| 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 Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.89
|
| 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 |
$41.66
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$39.57
|
| 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 |
$41.66
|
| Rate for Payer: United Healthcare Commercial |
$69.79
|
| Rate for Payer: United Healthcare Medicare |
$41.66
|
| 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 |
$42.35 |
| Max. Negotiated Rate |
$73.08 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$71.62
|
| Rate for Payer: Aetna of WY Medicare |
$46.77
|
| 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 |
$70.89
|
| 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 |
$44.58
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$42.35
|
| 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 |
$44.58
|
| Rate for Payer: United Healthcare Commercial |
$69.79
|
| Rate for Payer: United Healthcare Medicare |
$44.58
|
| 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 |
$39.57 |
| 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 Commercial |
$70.16
|
| Rate for Payer: Beech Street Commercial |
$71.62
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$70.89
|
| 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 |
$41.66
|
| Rate for Payer: HealthUtah PPO |
$73.08
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$70.89
|
| Rate for Payer: Multiplan Medicare/VA |
$39.57
|
| 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 |
$41.66
|
| Rate for Payer: United Healthcare Commercial |
$69.79
|
| Rate for Payer: United Healthcare Medicare |
$41.66
|
| Rate for Payer: WINHealth Partners Commercial |
$71.62
|
| Rate for Payer: Wise Provider Network Commercial |
$69.43
|
|
|
EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD
|
Professional
|
Both
|
$2,960.00
|
|
|
Service Code
|
HCPCS 15110
|
| Min. Negotiated Rate |
$582.59 |
| Max. Negotiated Rate |
$2,960.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,900.80
|
| Rate for Payer: Aetna of WY Medicare |
$685.40
|
| Rate for Payer: Beech Street Commercial |
$2,812.00
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: Cash Price |
$2,072.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,871.20
|
| Rate for Payer: Cigna of WY Commercial |
$2,900.80
|
| Rate for Payer: First Choice Health Commercial |
$2,664.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,812.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$685.40
|
| Rate for Payer: HealthUtah PPO |
$2,960.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,871.20
|
| Rate for Payer: Multiplan Medicare/VA |
$582.59
|
| Rate for Payer: One Health Plan of WY PPO |
$2,900.80
|
| Rate for Payer: PacificSource Commercial |
$2,664.00
|
| Rate for Payer: PHCS PPO |
$2,812.00
|
| Rate for Payer: Three Rivers PPO |
$2,220.00
|
| Rate for Payer: TriWest Veterans Administration |
$685.40
|
| Rate for Payer: United Healthcare Commercial |
$2,812.00
|
| Rate for Payer: WINHealth Partners Commercial |
$2,516.00
|
|
|
EPIMED 14G X 4" CURVED NEEDLE
|
Facility
|
OP
|
$3.50
|
|
| Hospital Charge Code |
2800293
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3.43
|
| Rate for Payer: Aetna of WY Medicare |
$2.31
|
| Rate for Payer: Altius Commercial |
$3.36
|
| Rate for Payer: Beech Street Commercial |
$3.43
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.45
|
| Rate for Payer: ChoiceCare Network Commercial |
$3.40
|
| Rate for Payer: Cigna of WY Commercial |
$3.43
|
| Rate for Payer: Entrust Commercial |
$3.32
|
| Rate for Payer: First Choice Health Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3.32
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$2.00
|
| Rate for Payer: HealthUtah PPO |
$3.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3.40
|
| Rate for Payer: Multiplan Medicare/VA |
$1.90
|
| Rate for Payer: One Health Plan of WY PPO |
$3.43
|
| Rate for Payer: PacificSource Commercial |
$3.15
|
| Rate for Payer: PHCS PPO |
$3.43
|
| Rate for Payer: Three Rivers PPO |
$2.62
|
| Rate for Payer: TriWest Veterans Administration |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$3.34
|
| Rate for Payer: United Healthcare Medicare |
$2.00
|
| Rate for Payer: WINHealth Partners Commercial |
$3.43
|
| Rate for Payer: Wise Provider Network Commercial |
$3.32
|
|
