|
ANOSCOPY W/RMVL LESION CAUTERY
|
Professional
|
Both
|
$3,677.00
|
|
|
Service Code
|
HCPCS 46610
|
| Min. Negotiated Rate |
$65.05 |
| Max. Negotiated Rate |
$3,677.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,603.46
|
| Rate for Payer: Aetna of WY Medicare |
$76.53
|
| Rate for Payer: Beech Street Commercial |
$3,493.15
|
| Rate for Payer: Cash Price |
$2,573.90
|
| Rate for Payer: Cash Price |
$2,573.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,566.69
|
| Rate for Payer: Cigna of WY Commercial |
$3,603.46
|
| Rate for Payer: First Choice Health Commercial |
$3,309.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,493.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$76.53
|
| Rate for Payer: HealthUtah PPO |
$3,677.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,566.69
|
| Rate for Payer: Multiplan Medicare/VA |
$65.05
|
| Rate for Payer: One Health Plan of WY PPO |
$3,603.46
|
| Rate for Payer: PacificSource Commercial |
$3,309.30
|
| Rate for Payer: PHCS PPO |
$3,493.15
|
| Rate for Payer: Three Rivers PPO |
$2,757.75
|
| Rate for Payer: TriWest Veterans Administration |
$76.53
|
| Rate for Payer: United Healthcare Commercial |
$3,493.15
|
| Rate for Payer: WINHealth Partners Commercial |
$3,125.45
|
|
|
ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX
|
Professional
|
Both
|
$4,804.00
|
|
|
Service Code
|
HCPCS 45990
|
| Min. Negotiated Rate |
$85.63 |
| Max. Negotiated Rate |
$4,804.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,707.92
|
| Rate for Payer: Aetna of WY Medicare |
$100.74
|
| Rate for Payer: Beech Street Commercial |
$4,563.80
|
| Rate for Payer: Cash Price |
$3,362.80
|
| Rate for Payer: Cash Price |
$3,362.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,659.88
|
| Rate for Payer: Cigna of WY Commercial |
$4,707.92
|
| Rate for Payer: First Choice Health Commercial |
$4,323.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,563.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$100.74
|
| Rate for Payer: HealthUtah PPO |
$4,804.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,659.88
|
| Rate for Payer: Multiplan Medicare/VA |
$85.63
|
| Rate for Payer: One Health Plan of WY PPO |
$4,707.92
|
| Rate for Payer: PacificSource Commercial |
$4,323.60
|
| Rate for Payer: PHCS PPO |
$4,563.80
|
| Rate for Payer: Three Rivers PPO |
$3,603.00
|
| Rate for Payer: TriWest Veterans Administration |
$100.74
|
| Rate for Payer: United Healthcare Commercial |
$4,563.80
|
| Rate for Payer: WINHealth Partners Commercial |
$4,083.40
|
|
|
ANTEPARTUM CARE ONLY 4-6 VISITS
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
HCPCS 59425
|
| Min. Negotiated Rate |
$346.77 |
| Max. Negotiated Rate |
$888.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$870.24
|
| Rate for Payer: Aetna of WY Medicare |
$407.96
|
| Rate for Payer: Beech Street Commercial |
$843.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: Cash Price |
$621.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$861.36
|
| Rate for Payer: Cigna of WY Commercial |
$870.24
|
| Rate for Payer: First Choice Health Commercial |
$799.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$843.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$407.96
|
| Rate for Payer: HealthUtah PPO |
$888.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$861.36
|
| Rate for Payer: Multiplan Medicare/VA |
$346.77
|
| Rate for Payer: One Health Plan of WY PPO |
$870.24
|
| Rate for Payer: PacificSource Commercial |
$799.20
|
| Rate for Payer: PHCS PPO |
$843.60
|
| Rate for Payer: Three Rivers PPO |
$666.00
|
| Rate for Payer: TriWest Veterans Administration |
$407.96
|
| Rate for Payer: United Healthcare Commercial |
$843.60
|
| Rate for Payer: WINHealth Partners Commercial |
$754.80
|
|
|
ANTEPARTUM CARE ONLY 7/> VISITS
|
Professional
|
Both
|
$1,564.00
|
|
|
Service Code
|
HCPCS 59426
|
| Min. Negotiated Rate |
$636.56 |
| Max. Negotiated Rate |
$1,532.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,532.72
|
| Rate for Payer: Aetna of WY Medicare |
$748.90
|
| Rate for Payer: Beech Street Commercial |
$1,485.80
|
| Rate for Payer: Cash Price |
$1,094.80
|
| Rate for Payer: Cash Price |
$1,094.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,517.08
|
| Rate for Payer: Cigna of WY Commercial |
$1,532.72
|
| Rate for Payer: First Choice Health Commercial |
$1,407.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,485.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$748.90
|
| Rate for Payer: HealthUtah PPO |
$1,137.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,517.08
|
| Rate for Payer: Multiplan Medicare/VA |
$636.56
|
| Rate for Payer: One Health Plan of WY PPO |
$1,532.72
|
| Rate for Payer: PacificSource Commercial |
$1,407.60
|
| Rate for Payer: PHCS PPO |
$1,485.80
|
| Rate for Payer: Three Rivers PPO |
$1,173.00
|
| Rate for Payer: TriWest Veterans Administration |
$748.90
|
| Rate for Payer: United Healthcare Commercial |
$1,485.80
|
| Rate for Payer: WINHealth Partners Commercial |
$1,329.40
|
|
|
ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
Both
|
$2,983.00
|
|
|
Service Code
|
HCPCS 57240
|
| Min. Negotiated Rate |
$503.78 |
| Max. Negotiated Rate |
$2,983.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,923.34
|
| Rate for Payer: Aetna of WY Medicare |
$592.68
|
| Rate for Payer: Beech Street Commercial |
$2,833.85
|
| Rate for Payer: Cash Price |
$2,088.10
|
| Rate for Payer: Cash Price |
$2,088.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,893.51
|
| Rate for Payer: Cigna of WY Commercial |
$2,923.34
|
| Rate for Payer: First Choice Health Commercial |
$2,684.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,833.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$592.68
|
| Rate for Payer: HealthUtah PPO |
$2,983.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,893.51
|
| Rate for Payer: Multiplan Medicare/VA |
$503.78
|
| Rate for Payer: One Health Plan of WY PPO |
$2,923.34
|
| Rate for Payer: PacificSource Commercial |
$2,684.70
|
| Rate for Payer: PHCS PPO |
$2,833.85
|
| Rate for Payer: Three Rivers PPO |
$2,237.25
|
| Rate for Payer: TriWest Veterans Administration |
$592.68
|
| Rate for Payer: United Healthcare Commercial |
$2,833.85
|
| Rate for Payer: WINHealth Partners Commercial |
$2,535.55
|
|
|
ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 22845 AS
|
| Min. Negotiated Rate |
$640.50 |
| Max. Negotiated Rate |
$854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.92
|
| Rate for Payer: Beech Street Commercial |
$811.30
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.38
|
| Rate for Payer: Cigna of WY Commercial |
$836.92
|
| Rate for Payer: First Choice Health Commercial |
$768.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.30
|
| Rate for Payer: HealthUtah PPO |
$854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.38
|
| Rate for Payer: One Health Plan of WY PPO |
$836.92
|
| Rate for Payer: PacificSource Commercial |
$768.60
|
| Rate for Payer: PHCS PPO |
$811.30
|
| Rate for Payer: Three Rivers PPO |
$640.50
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
| Rate for Payer: WINHealth Partners Commercial |
$725.90
|
|
|
ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$854.00
|
|
|
Service Code
|
HCPCS 22845 80
|
| Min. Negotiated Rate |
$640.50 |
| Max. Negotiated Rate |
$854.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$836.92
|
| Rate for Payer: Beech Street Commercial |
$811.30
|
| Rate for Payer: Cash Price |
$597.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$828.38
|
| Rate for Payer: Cigna of WY Commercial |
$836.92
|
| Rate for Payer: First Choice Health Commercial |
$768.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$811.30
|
| Rate for Payer: HealthUtah PPO |
$854.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$828.38
|
| Rate for Payer: One Health Plan of WY PPO |
$836.92
|
| Rate for Payer: PacificSource Commercial |
$768.60
|
| Rate for Payer: PHCS PPO |
$811.30
|
| Rate for Payer: Three Rivers PPO |
$640.50
|
| Rate for Payer: United Healthcare Commercial |
$811.30
|
| Rate for Payer: WINHealth Partners Commercial |
$725.90
|
|
|
ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS
|
Professional
|
Both
|
$2,435.00
|
|
|
Service Code
|
HCPCS 22846
|
| Min. Negotiated Rate |
$599.73 |
| Max. Negotiated Rate |
$2,435.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,386.30
|
| Rate for Payer: Aetna of WY Medicare |
$705.56
|
| Rate for Payer: Beech Street Commercial |
$2,313.25
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: Cash Price |
$1,704.50
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,361.95
|
| Rate for Payer: Cigna of WY Commercial |
$2,386.30
|
| Rate for Payer: First Choice Health Commercial |
$2,191.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,313.25
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$705.56
|
| Rate for Payer: HealthUtah PPO |
$2,435.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,361.95
|
| Rate for Payer: Multiplan Medicare/VA |
$599.73
|
| Rate for Payer: One Health Plan of WY PPO |
$2,386.30
|
| Rate for Payer: PacificSource Commercial |
$2,191.50
|
| Rate for Payer: PHCS PPO |
$2,313.25
|
| Rate for Payer: Three Rivers PPO |
$1,826.25
|
| Rate for Payer: TriWest Veterans Administration |
$705.56
|
| Rate for Payer: United Healthcare Commercial |
$2,313.25
|
| Rate for Payer: WINHealth Partners Commercial |
$2,069.75
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
HCPCS 27418 AS
|
| Min. Negotiated Rate |
$1,005.75 |
| Max. Negotiated Rate |
$1,341.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,314.18
|
| Rate for Payer: Beech Street Commercial |
$1,273.95
|
| Rate for Payer: Cash Price |
$938.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,300.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,314.18
|
| Rate for Payer: First Choice Health Commercial |
$1,206.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.95
|
| Rate for Payer: HealthUtah PPO |
$1,341.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,300.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,314.18
|
| Rate for Payer: PacificSource Commercial |
$1,206.90
|
| Rate for Payer: PHCS PPO |
$1,273.95
|
| Rate for Payer: Three Rivers PPO |
$1,005.75
|
| Rate for Payer: United Healthcare Commercial |
$1,273.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,139.85
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$1,341.00
|
|
|
Service Code
|
HCPCS 27418 80
|
| Min. Negotiated Rate |
$1,005.75 |
| Max. Negotiated Rate |
$1,341.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,314.18
|
| Rate for Payer: Beech Street Commercial |
$1,273.95
|
| Rate for Payer: Cash Price |
$938.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,300.77
|
| Rate for Payer: Cigna of WY Commercial |
$1,314.18
|
| Rate for Payer: First Choice Health Commercial |
$1,206.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,273.95
|
| Rate for Payer: HealthUtah PPO |
$1,341.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,300.77
|
| Rate for Payer: One Health Plan of WY PPO |
$1,314.18
|
| Rate for Payer: PacificSource Commercial |
$1,206.90
|
| Rate for Payer: PHCS PPO |
$1,273.95
|
| Rate for Payer: Three Rivers PPO |
$1,005.75
|
| Rate for Payer: United Healthcare Commercial |
$1,273.95
|
| Rate for Payer: WINHealth Partners Commercial |
$1,139.85
|
|
|
ANTERIOR TIBIAL TUBERCLEPLASTY
|
Professional
|
Both
|
$3,348.00
|
|
|
Service Code
|
HCPCS 27418
|
| Min. Negotiated Rate |
$678.03 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,281.04
|
| Rate for Payer: Aetna of WY Medicare |
$797.68
|
| Rate for Payer: Beech Street Commercial |
$3,180.60
|
| Rate for Payer: Cash Price |
$2,343.60
|
| Rate for Payer: Cash Price |
$2,343.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,247.56
|
| Rate for Payer: Cigna of WY Commercial |
$3,281.04
|
| Rate for Payer: First Choice Health Commercial |
$3,013.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,180.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$797.68
|
| Rate for Payer: HealthUtah PPO |
$3,348.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,247.56
|
| Rate for Payer: Multiplan Medicare/VA |
$678.03
|
| Rate for Payer: One Health Plan of WY PPO |
$3,281.04
|
| Rate for Payer: PacificSource Commercial |
$3,013.20
|
| Rate for Payer: PHCS PPO |
$3,180.60
|
| Rate for Payer: Three Rivers PPO |
$2,511.00
|
| Rate for Payer: TriWest Veterans Administration |
$797.68
|
| Rate for Payer: United Healthcare Commercial |
$3,180.60
|
| Rate for Payer: WINHealth Partners Commercial |
$2,845.80
|
|
|
ANTIBODY HELICOBACTER PYLORI
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 86677
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$98.00
|
| Rate for Payer: Aetna of WY Medicare |
$16.85
|
| Rate for Payer: Beech Street Commercial |
$95.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: Cash Price |
$70.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$97.00
|
| Rate for Payer: Cigna of WY Commercial |
$98.00
|
| Rate for Payer: First Choice Health Commercial |
$90.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$95.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$16.85
|
| Rate for Payer: HealthUtah PPO |
$100.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$97.00
|
| Rate for Payer: Multiplan Medicare/VA |
$14.32
|
| Rate for Payer: One Health Plan of WY PPO |
$98.00
|
| Rate for Payer: PacificSource Commercial |
$90.00
|
| Rate for Payer: PHCS PPO |
$95.00
|
| Rate for Payer: Three Rivers PPO |
$75.00
|
| Rate for Payer: TriWest Veterans Administration |
$16.85
|
| Rate for Payer: United Healthcare Commercial |
$95.00
|
| Rate for Payer: WINHealth Partners Commercial |
$95.00
|
|
|
ANTICOAG CLINIC PER SESSION
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS S9401
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$70.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$68.60
|
| Rate for Payer: Beech Street Commercial |
$66.50
|
| Rate for Payer: Cash Price |
$49.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$67.90
|
| Rate for Payer: Cigna of WY Commercial |
$68.60
|
| Rate for Payer: First Choice Health Commercial |
$63.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$66.50
|
| Rate for Payer: HealthUtah PPO |
$70.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$67.90
|
| Rate for Payer: One Health Plan of WY PPO |
$68.60
|
| Rate for Payer: PacificSource Commercial |
$63.00
|
| Rate for Payer: PHCS PPO |
$66.50
|
| Rate for Payer: Three Rivers PPO |
$52.50
|
| Rate for Payer: United Healthcare Commercial |
$66.50
|
| Rate for Payer: WINHealth Partners Commercial |
$66.50
|
|
|
ANTICOAGULANT MGMT FOR PT TAKING WARFARIN
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 93793
|
| Min. Negotiated Rate |
$9.39 |
| Max. Negotiated Rate |
$37.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$36.26
|
| Rate for Payer: Aetna of WY Medicare |
$11.05
|
| Rate for Payer: Beech Street Commercial |
$35.15
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: Cash Price |
$25.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$35.89
|
| Rate for Payer: Cigna of WY Commercial |
$36.26
|
| Rate for Payer: First Choice Health Commercial |
$33.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$35.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.05
|
| Rate for Payer: HealthUtah PPO |
$37.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$35.89
|
| Rate for Payer: Multiplan Medicare/VA |
$9.39
|
| Rate for Payer: One Health Plan of WY PPO |
$36.26
|
| Rate for Payer: PacificSource Commercial |
$33.30
|
| Rate for Payer: PHCS PPO |
$35.15
|
| Rate for Payer: Three Rivers PPO |
$27.75
|
| Rate for Payer: TriWest Veterans Administration |
$11.05
|
| Rate for Payer: United Healthcare Commercial |
$35.15
|
| Rate for Payer: WINHealth Partners Commercial |
$35.15
|
|
|
ANTIFOGGER KIT
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
4650004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.92
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.83
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.74
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.83
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$1.83
|
| Rate for Payer: WINHealth Partners Commercial |
$2.85
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
ANTIFOGGER KIT
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
4650004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.94
|
| Rate for Payer: Aetna of WY Medicare |
$1.98
|
| Rate for Payer: Altius Commercial |
$2.88
|
| Rate for Payer: Beech Street Commercial |
$2.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.91
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.91
|
| Rate for Payer: Cigna of WY Commercial |
$2.94
|
| Rate for Payer: Entrust Commercial |
$2.85
|
| Rate for Payer: First Choice Health Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.71
|
| Rate for Payer: HealthUtah PPO |
$3.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.91
|
| Rate for Payer: Multiplan Medicare/VA |
$1.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2.94
|
| Rate for Payer: PacificSource Commercial |
$2.70
|
| Rate for Payer: PHCS PPO |
$2.94
|
| Rate for Payer: Three Rivers PPO |
$2.25
|
| Rate for Payer: TriWest Veterans Administration |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicare |
$1.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2.94
|
| Rate for Payer: Wise Provider Network Commercial |
$2.85
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [40256]
|
Facility
|
OP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.81
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.92
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$11.33
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$19.98
|
| Rate for Payer: United Healthcare Medicare |
$11.92
|
| Rate for Payer: WINHealth Partners Commercial |
$20.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 1,000 UNIT-2,400 UNIT INTRAVENOUS SOLUTION [40256]
|
Facility
|
IP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.39
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.76
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$12.12
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$19.98
|
| Rate for Payer: United Healthcare Medicare |
$12.76
|
| Rate for Payer: WINHealth Partners Commercial |
$19.87
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [40255]
|
Facility
|
OP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.81
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.92
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$11.33
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$11.92
|
| Rate for Payer: United Healthcare Commercial |
$19.98
|
| Rate for Payer: United Healthcare Medicare |
$11.92
|
| Rate for Payer: WINHealth Partners Commercial |
$20.50
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIHEMOPHILIC FACTOR-VWF 250 UNIT-600 UNIT INTRAVENOUS SOLUTION [40255]
|
Facility
|
IP
|
$20.92
|
|
|
Service Code
|
HCPCS J7187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$20.92 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$20.50
|
| Rate for Payer: Aetna of WY Medicare |
$13.39
|
| Rate for Payer: Altius Commercial |
$20.08
|
| Rate for Payer: Beech Street Commercial |
$20.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$20.29
|
| Rate for Payer: Cash Price |
$14.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$20.29
|
| Rate for Payer: Cigna of WY Commercial |
$20.50
|
| Rate for Payer: Entrust Commercial |
$19.87
|
| Rate for Payer: First Choice Health Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$19.87
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$12.76
|
| Rate for Payer: HealthUtah PPO |
$20.92
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$20.29
|
| Rate for Payer: Multiplan Medicare/VA |
$12.12
|
| Rate for Payer: One Health Plan of WY PPO |
$20.50
|
| Rate for Payer: PacificSource Commercial |
$18.83
|
| Rate for Payer: PHCS PPO |
$20.50
|
| Rate for Payer: Three Rivers PPO |
$15.69
|
| Rate for Payer: TriWest Veterans Administration |
$12.76
|
| Rate for Payer: United Healthcare Commercial |
$19.98
|
| Rate for Payer: United Healthcare Medicare |
$12.76
|
| Rate for Payer: WINHealth Partners Commercial |
$19.87
|
| Rate for Payer: Wise Provider Network Commercial |
$19.87
|
|
|
ANTIREFLUX VALVE (SALEM)
|
Facility
|
OP
|
$10.91
|
|
| Hospital Charge Code |
4400007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.91 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.69
|
| Rate for Payer: Aetna of WY Medicare |
$7.20
|
| Rate for Payer: Altius Commercial |
$10.47
|
| Rate for Payer: Beech Street Commercial |
$10.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.58
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.58
|
| Rate for Payer: Cigna of WY Commercial |
$10.69
|
| Rate for Payer: Entrust Commercial |
$10.36
|
| Rate for Payer: First Choice Health Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.22
|
| Rate for Payer: HealthUtah PPO |
$10.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.58
|
| Rate for Payer: Multiplan Medicare/VA |
$5.91
|
| Rate for Payer: One Health Plan of WY PPO |
$10.69
|
| Rate for Payer: PacificSource Commercial |
$9.82
|
| Rate for Payer: PHCS PPO |
$10.69
|
| Rate for Payer: Three Rivers PPO |
$8.18
|
| Rate for Payer: TriWest Veterans Administration |
$6.22
|
| Rate for Payer: United Healthcare Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicare |
$6.22
|
| Rate for Payer: WINHealth Partners Commercial |
$10.69
|
| Rate for Payer: Wise Provider Network Commercial |
$10.36
|
|
|
ANTIREFLUX VALVE (SALEM)
|
Facility
|
IP
|
$10.91
|
|
| Hospital Charge Code |
4400007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.32 |
| Max. Negotiated Rate |
$10.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$10.69
|
| Rate for Payer: Aetna of WY Medicare |
$6.98
|
| Rate for Payer: Altius Commercial |
$10.47
|
| Rate for Payer: Beech Street Commercial |
$10.69
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$10.58
|
| Rate for Payer: Cash Price |
$7.64
|
| Rate for Payer: ChoiceCare Network Commercial |
$10.58
|
| Rate for Payer: Cigna of WY Commercial |
$10.69
|
| Rate for Payer: Entrust Commercial |
$10.36
|
| Rate for Payer: First Choice Health Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$10.36
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.66
|
| Rate for Payer: HealthUtah PPO |
$10.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$10.58
|
| Rate for Payer: Multiplan Medicare/VA |
$6.32
|
| Rate for Payer: One Health Plan of WY PPO |
$10.69
|
| Rate for Payer: PacificSource Commercial |
$9.82
|
| Rate for Payer: PHCS PPO |
$10.69
|
| Rate for Payer: Three Rivers PPO |
$8.18
|
| Rate for Payer: TriWest Veterans Administration |
$6.66
|
| Rate for Payer: United Healthcare Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicare |
$6.66
|
| Rate for Payer: WINHealth Partners Commercial |
$10.36
|
| Rate for Payer: Wise Provider Network Commercial |
$10.36
|
|
|
ANT VESICOURETHROPEXY/URETHROPEXY SMPL
|
Professional
|
Both
|
$3,018.00
|
|
|
Service Code
|
HCPCS 51840
|
| Min. Negotiated Rate |
$569.68 |
| Max. Negotiated Rate |
$3,018.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2,957.64
|
| Rate for Payer: Aetna of WY Medicare |
$670.21
|
| Rate for Payer: Beech Street Commercial |
$2,867.10
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: Cash Price |
$2,112.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$2,927.46
|
| Rate for Payer: Cigna of WY Commercial |
$2,957.64
|
| Rate for Payer: First Choice Health Commercial |
$2,716.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2,867.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$670.21
|
| Rate for Payer: HealthUtah PPO |
$3,018.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2,927.46
|
| Rate for Payer: Multiplan Medicare/VA |
$569.68
|
| Rate for Payer: One Health Plan of WY PPO |
$2,957.64
|
| Rate for Payer: PacificSource Commercial |
$2,716.20
|
| Rate for Payer: PHCS PPO |
$2,867.10
|
| Rate for Payer: Three Rivers PPO |
$2,263.50
|
| Rate for Payer: TriWest Veterans Administration |
$670.21
|
| Rate for Payer: United Healthcare Commercial |
$2,867.10
|
| Rate for Payer: WINHealth Partners Commercial |
$2,565.30
|
|
|
APIXABAN 2.5 MG TABLET [125708]
|
Facility
|
OP
|
$47.20
|
|
|
Service Code
|
NDC 0003089331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.26
|
| Rate for Payer: Aetna of WY Medicare |
$31.15
|
| Rate for Payer: Altius Commercial |
$45.31
|
| Rate for Payer: Beech Street Commercial |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.78
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.78
|
| Rate for Payer: Cigna of WY Commercial |
$46.26
|
| Rate for Payer: Entrust Commercial |
$44.84
|
| Rate for Payer: First Choice Health Commercial |
$44.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$26.90
|
| Rate for Payer: HealthUtah PPO |
$47.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.78
|
| Rate for Payer: Multiplan Medicare/VA |
$25.56
|
| Rate for Payer: One Health Plan of WY PPO |
$46.26
|
| Rate for Payer: PacificSource Commercial |
$42.48
|
| Rate for Payer: PHCS PPO |
$46.26
|
| Rate for Payer: Three Rivers PPO |
$35.40
|
| Rate for Payer: TriWest Veterans Administration |
$26.90
|
| Rate for Payer: United Healthcare Commercial |
$45.08
|
| Rate for Payer: United Healthcare Medicare |
$26.90
|
| Rate for Payer: WINHealth Partners Commercial |
$46.26
|
| Rate for Payer: Wise Provider Network Commercial |
$44.84
|
|
|
APIXABAN 2.5 MG TABLET [125708]
|
Facility
|
IP
|
$47.20
|
|
|
Service Code
|
NDC 0003089331
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.35 |
| Max. Negotiated Rate |
$47.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$46.26
|
| Rate for Payer: Aetna of WY Medicare |
$30.21
|
| Rate for Payer: Altius Commercial |
$45.31
|
| Rate for Payer: Beech Street Commercial |
$46.26
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$45.78
|
| Rate for Payer: Cash Price |
$33.04
|
| Rate for Payer: ChoiceCare Network Commercial |
$45.78
|
| Rate for Payer: Cigna of WY Commercial |
$46.26
|
| Rate for Payer: Entrust Commercial |
$44.84
|
| Rate for Payer: First Choice Health Commercial |
$44.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$44.84
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.79
|
| Rate for Payer: HealthUtah PPO |
$47.20
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$45.78
|
| Rate for Payer: Multiplan Medicare/VA |
$27.35
|
| Rate for Payer: One Health Plan of WY PPO |
$46.26
|
| Rate for Payer: PacificSource Commercial |
$42.48
|
| Rate for Payer: PHCS PPO |
$46.26
|
| Rate for Payer: Three Rivers PPO |
$35.40
|
| Rate for Payer: TriWest Veterans Administration |
$28.79
|
| Rate for Payer: United Healthcare Commercial |
$45.08
|
| Rate for Payer: United Healthcare Medicare |
$28.79
|
| Rate for Payer: WINHealth Partners Commercial |
$44.84
|
| Rate for Payer: Wise Provider Network Commercial |
$44.84
|
|
