|
BLADE SAGITTAL SAW 90 DEG ANGLE
|
Facility
|
IP
|
$108.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$108.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$106.50
|
| Rate for Payer: Altius Auto/Workers Compensation |
$104.32
|
| Rate for Payer: Altius Commercial |
$104.32
|
| Rate for Payer: Beech Street Commercial |
$106.50
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$89.22
|
| Rate for Payer: Cash Price |
$76.07
|
| Rate for Payer: ChoiceCare Network Commercial |
$105.41
|
| Rate for Payer: Cigna of WY Commercial |
$106.50
|
| Rate for Payer: Entrust Commercial |
$103.24
|
| Rate for Payer: First Choice Health Commercial |
$103.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$103.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$71.72
|
| Rate for Payer: HealthUtah PPO |
$108.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$105.41
|
| Rate for Payer: Multiplan Medicare/VA |
$68.14
|
| Rate for Payer: One Health Plan of WY PPO |
$106.50
|
| Rate for Payer: PacificSource Commercial |
$97.80
|
| Rate for Payer: PHCS PPO |
$106.50
|
| Rate for Payer: Three Rivers PPO |
$81.50
|
| Rate for Payer: TriWest Veterans Administration |
$71.72
|
| Rate for Payer: United Healthcare Commercial |
$94.54
|
| Rate for Payer: United Healthcare Medicare |
$71.72
|
| Rate for Payer: WINHealth Partners Commercial |
$103.24
|
| Rate for Payer: Wise Provider Network Commercial |
$103.24
|
|
|
BL AG LG MED 9.0X31 2296-3-525
|
Facility
|
IP
|
$74.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.09
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.60
|
| Rate for Payer: Altius Commercial |
$71.60
|
| Rate for Payer: Beech Street Commercial |
$73.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.23
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.34
|
| Rate for Payer: Cigna of WY Commercial |
$73.09
|
| Rate for Payer: Entrust Commercial |
$70.85
|
| Rate for Payer: First Choice Health Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$49.22
|
| Rate for Payer: HealthUtah PPO |
$74.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.34
|
| Rate for Payer: Multiplan Medicare/VA |
$46.76
|
| Rate for Payer: One Health Plan of WY PPO |
$73.09
|
| Rate for Payer: PacificSource Commercial |
$67.12
|
| Rate for Payer: PHCS PPO |
$73.09
|
| Rate for Payer: Three Rivers PPO |
$55.94
|
| Rate for Payer: TriWest Veterans Administration |
$49.22
|
| Rate for Payer: United Healthcare Commercial |
$64.88
|
| Rate for Payer: United Healthcare Medicare |
$49.22
|
| Rate for Payer: WINHealth Partners Commercial |
$70.85
|
| Rate for Payer: Wise Provider Network Commercial |
$70.85
|
|
|
BL AG LG MED 9.0X31 2296-3-525
|
Facility
|
OP
|
$74.58
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.09 |
| Max. Negotiated Rate |
$74.58 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$73.09
|
| Rate for Payer: Aetna of WY Medicare |
$49.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$71.60
|
| Rate for Payer: Altius Commercial |
$71.60
|
| Rate for Payer: Beech Street Commercial |
$73.09
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$61.23
|
| Rate for Payer: Cash Price |
$52.21
|
| Rate for Payer: ChoiceCare Network Commercial |
$72.34
|
| Rate for Payer: Cigna of WY Commercial |
$73.09
|
| Rate for Payer: Entrust Commercial |
$70.85
|
| Rate for Payer: First Choice Health Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$70.85
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$43.26
|
| Rate for Payer: HealthUtah PPO |
$74.58
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$72.34
|
| Rate for Payer: Multiplan Medicare/VA |
$41.09
|
| Rate for Payer: One Health Plan of WY PPO |
$73.09
|
| Rate for Payer: PacificSource Commercial |
$67.12
|
| Rate for Payer: PHCS PPO |
$73.09
|
| Rate for Payer: Three Rivers PPO |
$55.94
|
| Rate for Payer: TriWest Veterans Administration |
$43.26
|
| Rate for Payer: United Healthcare Commercial |
$64.88
|
| Rate for Payer: United Healthcare Medicare |
$43.26
|
| Rate for Payer: WINHealth Partners Commercial |
$73.09
|
| Rate for Payer: Wise Provider Network Commercial |
$70.85
|
|
|
BLAKEMORE 20FR BALLOON ADULT
|
Facility
|
OP
|
$1,061.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$584.94 |
| Max. Negotiated Rate |
$1,061.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,040.36
|
| Rate for Payer: Aetna of WY Medicare |
$700.65
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,019.13
|
| Rate for Payer: Altius Commercial |
$1,019.13
|
| Rate for Payer: Beech Street Commercial |
$1,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$871.57
|
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,029.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,040.36
|
| Rate for Payer: Entrust Commercial |
$1,008.51
|
| Rate for Payer: First Choice Health Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$615.72
|
| Rate for Payer: HealthUtah PPO |
$1,061.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,029.74
|
| Rate for Payer: Multiplan Medicare/VA |
$584.94
|
| Rate for Payer: One Health Plan of WY PPO |
$1,040.36
|
| Rate for Payer: PacificSource Commercial |
$955.43
|
| Rate for Payer: PHCS PPO |
$1,040.36
|
| Rate for Payer: Three Rivers PPO |
$796.19
|
| Rate for Payer: TriWest Veterans Administration |
$615.72
|
| Rate for Payer: United Healthcare Commercial |
$923.58
|
| Rate for Payer: United Healthcare Medicare |
$615.72
|
| Rate for Payer: WINHealth Partners Commercial |
$1,040.36
|
| Rate for Payer: Wise Provider Network Commercial |
$1,008.51
|
|
|
BLAKEMORE 20FR BALLOON ADULT
|
Facility
|
IP
|
$1,061.59
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.62 |
| Max. Negotiated Rate |
$1,061.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,040.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$1,019.13
|
| Rate for Payer: Altius Commercial |
$1,019.13
|
| Rate for Payer: Beech Street Commercial |
$1,040.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$871.57
|
| Rate for Payer: Cash Price |
$743.11
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,029.74
|
| Rate for Payer: Cigna of WY Commercial |
$1,040.36
|
| Rate for Payer: Entrust Commercial |
$1,008.51
|
| Rate for Payer: First Choice Health Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,008.51
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$700.65
|
| Rate for Payer: HealthUtah PPO |
$1,061.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,029.74
|
| Rate for Payer: Multiplan Medicare/VA |
$665.62
|
| Rate for Payer: One Health Plan of WY PPO |
$1,040.36
|
| Rate for Payer: PacificSource Commercial |
$955.43
|
| Rate for Payer: PHCS PPO |
$1,040.36
|
| Rate for Payer: Three Rivers PPO |
$796.19
|
| Rate for Payer: TriWest Veterans Administration |
$700.65
|
| Rate for Payer: United Healthcare Commercial |
$923.58
|
| Rate for Payer: United Healthcare Medicare |
$700.65
|
| Rate for Payer: WINHealth Partners Commercial |
$1,008.51
|
| Rate for Payer: Wise Provider Network Commercial |
$1,008.51
|
|
|
BLD AG XLG WD 39X13 2296-3-508
|
Facility
|
OP
|
$87.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.61
|
| Rate for Payer: Aetna of WY Medicare |
$57.66
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.87
|
| Rate for Payer: Altius Commercial |
$83.87
|
| Rate for Payer: Beech Street Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.72
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.74
|
| Rate for Payer: Cigna of WY Commercial |
$85.61
|
| Rate for Payer: Entrust Commercial |
$82.99
|
| Rate for Payer: First Choice Health Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$50.67
|
| Rate for Payer: HealthUtah PPO |
$87.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.74
|
| Rate for Payer: Multiplan Medicare/VA |
$48.14
|
| Rate for Payer: One Health Plan of WY PPO |
$85.61
|
| Rate for Payer: PacificSource Commercial |
$78.62
|
| Rate for Payer: PHCS PPO |
$85.61
|
| Rate for Payer: Three Rivers PPO |
$65.52
|
| Rate for Payer: TriWest Veterans Administration |
$50.67
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare |
$50.67
|
| Rate for Payer: WINHealth Partners Commercial |
$85.61
|
| Rate for Payer: Wise Provider Network Commercial |
$82.99
|
|
|
BLD AG XLG WD 39X13 2296-3-508
|
Facility
|
IP
|
$87.36
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.77 |
| Max. Negotiated Rate |
$87.36 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$85.61
|
| Rate for Payer: Altius Auto/Workers Compensation |
$83.87
|
| Rate for Payer: Altius Commercial |
$83.87
|
| Rate for Payer: Beech Street Commercial |
$85.61
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$71.72
|
| Rate for Payer: Cash Price |
$61.15
|
| Rate for Payer: ChoiceCare Network Commercial |
$84.74
|
| Rate for Payer: Cigna of WY Commercial |
$85.61
|
| Rate for Payer: Entrust Commercial |
$82.99
|
| Rate for Payer: First Choice Health Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$82.99
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$57.66
|
| Rate for Payer: HealthUtah PPO |
$87.36
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$84.74
|
| Rate for Payer: Multiplan Medicare/VA |
$54.77
|
| Rate for Payer: One Health Plan of WY PPO |
$85.61
|
| Rate for Payer: PacificSource Commercial |
$78.62
|
| Rate for Payer: PHCS PPO |
$85.61
|
| Rate for Payer: Three Rivers PPO |
$65.52
|
| Rate for Payer: TriWest Veterans Administration |
$57.66
|
| Rate for Payer: United Healthcare Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicare |
$57.66
|
| Rate for Payer: WINHealth Partners Commercial |
$82.99
|
| Rate for Payer: Wise Provider Network Commercial |
$82.99
|
|
|
BLDR IRRIGATION SMPL LAVAGE &/INSTLJ
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 51700
|
| Hospital Charge Code |
51700
|
| Min. Negotiated Rate |
$24.19 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$157.78
|
| Rate for Payer: Aetna of WY Medicare |
$28.46
|
| Rate for Payer: Beech Street Commercial |
$152.95
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: Cash Price |
$112.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$156.17
|
| Rate for Payer: Cigna of WY Commercial |
$157.78
|
| Rate for Payer: First Choice Health Commercial |
$144.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$152.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$28.46
|
| Rate for Payer: HealthUtah PPO |
$161.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$156.17
|
| Rate for Payer: Multiplan Medicare/VA |
$24.19
|
| Rate for Payer: One Health Plan of WY PPO |
$157.78
|
| Rate for Payer: PacificSource Commercial |
$144.90
|
| Rate for Payer: PHCS PPO |
$152.95
|
| Rate for Payer: Three Rivers PPO |
$120.75
|
| Rate for Payer: TriWest Veterans Administration |
$28.46
|
| Rate for Payer: United Healthcare Commercial |
$140.07
|
| Rate for Payer: United Healthcare Medicare |
$28.46
|
| Rate for Payer: WINHealth Partners Commercial |
$136.85
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [11480]
|
Facility
|
OP
|
$103.31
|
|
|
Service Code
|
HCPCS J9040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.92 |
| Max. Negotiated Rate |
$103.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.24
|
| Rate for Payer: Aetna of WY Medicare |
$68.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$99.18
|
| Rate for Payer: Altius Commercial |
$99.18
|
| Rate for Payer: Beech Street Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$72.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.21
|
| Rate for Payer: Cigna of WY Commercial |
$101.24
|
| Rate for Payer: Entrust Commercial |
$98.14
|
| Rate for Payer: First Choice Health Commercial |
$98.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$59.92
|
| Rate for Payer: HealthUtah PPO |
$103.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.21
|
| Rate for Payer: Multiplan Medicare/VA |
$56.92
|
| Rate for Payer: One Health Plan of WY PPO |
$101.24
|
| Rate for Payer: PacificSource Commercial |
$92.98
|
| Rate for Payer: PHCS PPO |
$101.24
|
| Rate for Payer: Three Rivers PPO |
$77.48
|
| Rate for Payer: TriWest Veterans Administration |
$59.92
|
| Rate for Payer: United Healthcare Commercial |
$89.88
|
| Rate for Payer: United Healthcare Medicare |
$59.92
|
| Rate for Payer: WINHealth Partners Commercial |
$101.24
|
| Rate for Payer: Wise Provider Network Commercial |
$98.14
|
|
|
BLEOMYCIN 15 UNIT SOLUTION FOR INJECTION [11480]
|
Facility
|
IP
|
$103.31
|
|
|
Service Code
|
HCPCS J9040
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.78 |
| Max. Negotiated Rate |
$103.31 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$101.24
|
| Rate for Payer: Altius Auto/Workers Compensation |
$99.18
|
| Rate for Payer: Altius Commercial |
$99.18
|
| Rate for Payer: Beech Street Commercial |
$101.24
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$84.82
|
| Rate for Payer: Cash Price |
$72.31
|
| Rate for Payer: ChoiceCare Network Commercial |
$100.21
|
| Rate for Payer: Cigna of WY Commercial |
$101.24
|
| Rate for Payer: Entrust Commercial |
$98.14
|
| Rate for Payer: First Choice Health Commercial |
$98.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$98.14
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$68.18
|
| Rate for Payer: HealthUtah PPO |
$103.31
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$100.21
|
| Rate for Payer: Multiplan Medicare/VA |
$64.78
|
| Rate for Payer: One Health Plan of WY PPO |
$101.24
|
| Rate for Payer: PacificSource Commercial |
$92.98
|
| Rate for Payer: PHCS PPO |
$101.24
|
| Rate for Payer: Three Rivers PPO |
$77.48
|
| Rate for Payer: TriWest Veterans Administration |
$68.18
|
| Rate for Payer: United Healthcare Commercial |
$89.88
|
| Rate for Payer: United Healthcare Medicare |
$68.18
|
| Rate for Payer: WINHealth Partners Commercial |
$98.14
|
| Rate for Payer: Wise Provider Network Commercial |
$98.14
|
|
|
BLOOD COUNT COMPLETE AUTO&AUTO DIFRNTL WBC
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
85025
|
| Min. Negotiated Rate |
$6.60 |
| Max. Negotiated Rate |
$61.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$59.78
|
| Rate for Payer: Aetna of WY Medicare |
$7.77
|
| Rate for Payer: Beech Street Commercial |
$57.95
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: Cash Price |
$42.70
|
| Rate for Payer: ChoiceCare Network Commercial |
$59.17
|
| Rate for Payer: Cigna of WY Commercial |
$59.78
|
| Rate for Payer: First Choice Health Commercial |
$54.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$57.95
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.77
|
| Rate for Payer: HealthUtah PPO |
$61.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$59.17
|
| Rate for Payer: Multiplan Medicare/VA |
$6.60
|
| Rate for Payer: One Health Plan of WY PPO |
$59.78
|
| Rate for Payer: PacificSource Commercial |
$54.90
|
| Rate for Payer: PHCS PPO |
$57.95
|
| Rate for Payer: Three Rivers PPO |
$45.75
|
| Rate for Payer: TriWest Veterans Administration |
$7.77
|
| Rate for Payer: United Healthcare Commercial |
$53.07
|
| Rate for Payer: United Healthcare Medicare |
$7.77
|
| Rate for Payer: WINHealth Partners Commercial |
$57.95
|
|
|
BLOOD COUNT SPUN MICROHEMATOCRIT
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 85013
|
| Hospital Charge Code |
85013
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$38.22
|
| Rate for Payer: Aetna of WY Medicare |
$7.00
|
| Rate for Payer: Beech Street Commercial |
$37.05
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$37.83
|
| Rate for Payer: Cigna of WY Commercial |
$38.22
|
| Rate for Payer: First Choice Health Commercial |
$35.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$37.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.00
|
| Rate for Payer: HealthUtah PPO |
$39.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$37.83
|
| Rate for Payer: Multiplan Medicare/VA |
$5.95
|
| Rate for Payer: One Health Plan of WY PPO |
$38.22
|
| Rate for Payer: PacificSource Commercial |
$35.10
|
| Rate for Payer: PHCS PPO |
$37.05
|
| Rate for Payer: Three Rivers PPO |
$29.25
|
| Rate for Payer: TriWest Veterans Administration |
$7.00
|
| Rate for Payer: United Healthcare Commercial |
$33.93
|
| Rate for Payer: United Healthcare Medicare |
$7.00
|
| Rate for Payer: WINHealth Partners Commercial |
$37.05
|
|
|
BLOOD OCCULT PEROXIDASE ACTV QUAL FECES 1 DETER
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 82270
|
| Hospital Charge Code |
82270
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$33.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.34
|
| Rate for Payer: Aetna of WY Medicare |
$4.38
|
| Rate for Payer: Beech Street Commercial |
$31.35
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.01
|
| Rate for Payer: Cigna of WY Commercial |
$32.34
|
| Rate for Payer: First Choice Health Commercial |
$29.70
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.35
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$4.38
|
| Rate for Payer: HealthUtah PPO |
$33.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.01
|
| Rate for Payer: Multiplan Medicare/VA |
$3.72
|
| Rate for Payer: One Health Plan of WY PPO |
$32.34
|
| Rate for Payer: PacificSource Commercial |
$29.70
|
| Rate for Payer: PHCS PPO |
$31.35
|
| Rate for Payer: Three Rivers PPO |
$24.75
|
| Rate for Payer: TriWest Veterans Administration |
$4.38
|
| Rate for Payer: United Healthcare Commercial |
$28.71
|
| Rate for Payer: United Healthcare Medicare |
$4.38
|
| Rate for Payer: WINHealth Partners Commercial |
$31.35
|
|
|
BLOOD SUGAR DIAGNOSTIC STRIPS [7214]
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 8770142626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.54
|
| Rate for Payer: Aetna of WY Medicare |
$1.71
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.49
|
| Rate for Payer: Altius Commercial |
$2.49
|
| Rate for Payer: Beech Street Commercial |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.51
|
| Rate for Payer: Cigna of WY Commercial |
$2.54
|
| Rate for Payer: Entrust Commercial |
$2.46
|
| Rate for Payer: First Choice Health Commercial |
$2.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.50
|
| Rate for Payer: HealthUtah PPO |
$2.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1.43
|
| Rate for Payer: One Health Plan of WY PPO |
$2.54
|
| Rate for Payer: PacificSource Commercial |
$2.33
|
| Rate for Payer: PHCS PPO |
$2.54
|
| Rate for Payer: Three Rivers PPO |
$1.94
|
| Rate for Payer: TriWest Veterans Administration |
$1.50
|
| Rate for Payer: United Healthcare Commercial |
$2.25
|
| Rate for Payer: United Healthcare Medicare |
$1.50
|
| Rate for Payer: WINHealth Partners Commercial |
$2.54
|
| Rate for Payer: Wise Provider Network Commercial |
$2.46
|
|
|
BLOOD SUGAR DIAGNOSTIC STRIPS [7214]
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 8770142626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.62 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$2.54
|
| Rate for Payer: Altius Auto/Workers Compensation |
$2.49
|
| Rate for Payer: Altius Commercial |
$2.49
|
| Rate for Payer: Beech Street Commercial |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$2.51
|
| Rate for Payer: Cigna of WY Commercial |
$2.54
|
| Rate for Payer: Entrust Commercial |
$2.46
|
| Rate for Payer: First Choice Health Commercial |
$2.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$2.46
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$1.71
|
| Rate for Payer: HealthUtah PPO |
$2.59
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$2.51
|
| Rate for Payer: Multiplan Medicare/VA |
$1.62
|
| Rate for Payer: One Health Plan of WY PPO |
$2.54
|
| Rate for Payer: PacificSource Commercial |
$2.33
|
| Rate for Payer: PHCS PPO |
$2.54
|
| Rate for Payer: Three Rivers PPO |
$1.94
|
| Rate for Payer: TriWest Veterans Administration |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$2.25
|
| Rate for Payer: United Healthcare Medicare |
$1.71
|
| Rate for Payer: WINHealth Partners Commercial |
$2.46
|
| Rate for Payer: Wise Provider Network Commercial |
$2.46
|
|
|
BONE AGE STUDIES
|
Professional
|
Both
|
$438.00
|
|
|
Service Code
|
HCPCS 77072
|
| Hospital Charge Code |
77072
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$438.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$429.24
|
| Rate for Payer: Aetna of WY Medicare |
$25.37
|
| Rate for Payer: Beech Street Commercial |
$416.10
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: Cash Price |
$306.60
|
| Rate for Payer: ChoiceCare Network Commercial |
$424.86
|
| Rate for Payer: Cigna of WY Commercial |
$429.24
|
| Rate for Payer: First Choice Health Commercial |
$394.20
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$416.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$25.37
|
| Rate for Payer: HealthUtah PPO |
$438.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$424.86
|
| Rate for Payer: Multiplan Medicare/VA |
$21.56
|
| Rate for Payer: One Health Plan of WY PPO |
$429.24
|
| Rate for Payer: PacificSource Commercial |
$394.20
|
| Rate for Payer: PHCS PPO |
$416.10
|
| Rate for Payer: Three Rivers PPO |
$328.50
|
| Rate for Payer: TriWest Veterans Administration |
$25.37
|
| Rate for Payer: United Healthcare Commercial |
$381.06
|
| Rate for Payer: United Healthcare Medicare |
$25.37
|
| Rate for Payer: WINHealth Partners Commercial |
$416.10
|
|
|
BONE FOAM ROLL
|
Facility
|
OP
|
$157.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$86.78 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Aetna of WY Medicare |
$103.95
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.20
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.31
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$91.35
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$86.78
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$91.35
|
| Rate for Payer: United Healthcare Commercial |
$137.02
|
| Rate for Payer: United Healthcare Medicare |
$91.35
|
| Rate for Payer: WINHealth Partners Commercial |
$154.35
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
BONE FOAM ROLL
|
Facility
|
IP
|
$157.50
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$98.75 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$154.35
|
| Rate for Payer: Altius Auto/Workers Compensation |
$151.20
|
| Rate for Payer: Altius Commercial |
$151.20
|
| Rate for Payer: Beech Street Commercial |
$154.35
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$129.31
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: ChoiceCare Network Commercial |
$152.78
|
| Rate for Payer: Cigna of WY Commercial |
$154.35
|
| Rate for Payer: Entrust Commercial |
$149.62
|
| Rate for Payer: First Choice Health Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$149.62
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$103.95
|
| Rate for Payer: HealthUtah PPO |
$157.50
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$152.78
|
| Rate for Payer: Multiplan Medicare/VA |
$98.75
|
| Rate for Payer: One Health Plan of WY PPO |
$154.35
|
| Rate for Payer: PacificSource Commercial |
$141.75
|
| Rate for Payer: PHCS PPO |
$154.35
|
| Rate for Payer: Three Rivers PPO |
$118.12
|
| Rate for Payer: TriWest Veterans Administration |
$103.95
|
| Rate for Payer: United Healthcare Commercial |
$137.02
|
| Rate for Payer: United Healthcare Medicare |
$103.95
|
| Rate for Payer: WINHealth Partners Commercial |
$149.62
|
| Rate for Payer: Wise Provider Network Commercial |
$149.62
|
|
|
BONE GRAFT ANY DONOR AREA MAJOR/LARGE
|
Professional
|
Both
|
$1,444.00
|
|
|
Service Code
|
HCPCS 20902
|
| Hospital Charge Code |
20902
|
| Min. Negotiated Rate |
$222.61 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$1,415.12
|
| Rate for Payer: Aetna of WY Medicare |
$261.89
|
| Rate for Payer: Beech Street Commercial |
$1,371.80
|
| Rate for Payer: Cash Price |
$1,010.80
|
| Rate for Payer: Cash Price |
$1,010.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$1,400.68
|
| Rate for Payer: Cigna of WY Commercial |
$1,415.12
|
| Rate for Payer: First Choice Health Commercial |
$1,299.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$1,371.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$261.89
|
| Rate for Payer: HealthUtah PPO |
$1,444.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$1,400.68
|
| Rate for Payer: Multiplan Medicare/VA |
$222.61
|
| Rate for Payer: One Health Plan of WY PPO |
$1,415.12
|
| Rate for Payer: PacificSource Commercial |
$1,299.60
|
| Rate for Payer: PHCS PPO |
$1,371.80
|
| Rate for Payer: Three Rivers PPO |
$1,083.00
|
| Rate for Payer: TriWest Veterans Administration |
$261.89
|
| Rate for Payer: United Healthcare Commercial |
$1,256.28
|
| Rate for Payer: United Healthcare Medicare |
$261.89
|
| Rate for Payer: WINHealth Partners Commercial |
$1,227.40
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 20900 80
|
| Hospital Charge Code |
20900
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$925.12
|
| Rate for Payer: Aetna of WY Medicare |
$172.22
|
| Rate for Payer: Beech Street Commercial |
$896.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$915.68
|
| Rate for Payer: Cigna of WY Commercial |
$925.12
|
| Rate for Payer: First Choice Health Commercial |
$849.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$896.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.22
|
| Rate for Payer: HealthUtah PPO |
$944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$915.68
|
| Rate for Payer: Multiplan Medicare/VA |
$146.39
|
| Rate for Payer: One Health Plan of WY PPO |
$925.12
|
| Rate for Payer: PacificSource Commercial |
$849.60
|
| Rate for Payer: PHCS PPO |
$896.80
|
| Rate for Payer: Three Rivers PPO |
$708.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.22
|
| Rate for Payer: United Healthcare Commercial |
$821.28
|
| Rate for Payer: United Healthcare Medicare |
$172.22
|
| Rate for Payer: WINHealth Partners Commercial |
$802.40
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 20900
|
| Hospital Charge Code |
20900
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$925.12
|
| Rate for Payer: Aetna of WY Medicare |
$172.22
|
| Rate for Payer: Beech Street Commercial |
$896.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$915.68
|
| Rate for Payer: Cigna of WY Commercial |
$925.12
|
| Rate for Payer: First Choice Health Commercial |
$849.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$896.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.22
|
| Rate for Payer: HealthUtah PPO |
$944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$915.68
|
| Rate for Payer: Multiplan Medicare/VA |
$146.39
|
| Rate for Payer: One Health Plan of WY PPO |
$925.12
|
| Rate for Payer: PacificSource Commercial |
$849.60
|
| Rate for Payer: PHCS PPO |
$896.80
|
| Rate for Payer: Three Rivers PPO |
$708.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.22
|
| Rate for Payer: United Healthcare Commercial |
$821.28
|
| Rate for Payer: United Healthcare Medicare |
$172.22
|
| Rate for Payer: WINHealth Partners Commercial |
$802.40
|
|
|
BONE GRAFT ANY DONOR AREA MINOR/SMALL
|
Professional
|
Both
|
$944.00
|
|
|
Service Code
|
HCPCS 20900 AS
|
| Hospital Charge Code |
20900
|
| Min. Negotiated Rate |
$146.39 |
| Max. Negotiated Rate |
$944.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$925.12
|
| Rate for Payer: Aetna of WY Medicare |
$172.22
|
| Rate for Payer: Beech Street Commercial |
$896.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$915.68
|
| Rate for Payer: Cigna of WY Commercial |
$925.12
|
| Rate for Payer: First Choice Health Commercial |
$849.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$896.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$172.22
|
| Rate for Payer: HealthUtah PPO |
$944.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$915.68
|
| Rate for Payer: Multiplan Medicare/VA |
$146.39
|
| Rate for Payer: One Health Plan of WY PPO |
$925.12
|
| Rate for Payer: PacificSource Commercial |
$849.60
|
| Rate for Payer: PHCS PPO |
$896.80
|
| Rate for Payer: Three Rivers PPO |
$708.00
|
| Rate for Payer: TriWest Veterans Administration |
$172.22
|
| Rate for Payer: United Healthcare Commercial |
$821.28
|
| Rate for Payer: United Healthcare Medicare |
$172.22
|
| Rate for Payer: WINHealth Partners Commercial |
$802.40
|
|
|
BONE LENGTH STUDIES
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 77073
|
| Hospital Charge Code |
77073
|
| Min. Negotiated Rate |
$37.64 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$506.66
|
| Rate for Payer: Aetna of WY Medicare |
$44.28
|
| Rate for Payer: Beech Street Commercial |
$491.15
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: Cash Price |
$361.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$501.49
|
| Rate for Payer: Cigna of WY Commercial |
$506.66
|
| Rate for Payer: First Choice Health Commercial |
$465.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$491.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$44.28
|
| Rate for Payer: HealthUtah PPO |
$517.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$501.49
|
| Rate for Payer: Multiplan Medicare/VA |
$37.64
|
| Rate for Payer: One Health Plan of WY PPO |
$506.66
|
| Rate for Payer: PacificSource Commercial |
$465.30
|
| Rate for Payer: PHCS PPO |
$491.15
|
| Rate for Payer: Three Rivers PPO |
$387.75
|
| Rate for Payer: TriWest Veterans Administration |
$44.28
|
| Rate for Payer: United Healthcare Commercial |
$449.79
|
| Rate for Payer: United Healthcare Medicare |
$44.28
|
| Rate for Payer: WINHealth Partners Commercial |
$491.15
|
|
|
BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 20939
|
| Hospital Charge Code |
20939
|
| Min. Negotiated Rate |
$55.42 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$315.56
|
| Rate for Payer: Aetna of WY Medicare |
$65.20
|
| Rate for Payer: Beech Street Commercial |
$305.90
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: Cash Price |
$225.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$312.34
|
| Rate for Payer: Cigna of WY Commercial |
$315.56
|
| Rate for Payer: First Choice Health Commercial |
$289.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$305.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$65.20
|
| Rate for Payer: HealthUtah PPO |
$322.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$312.34
|
| Rate for Payer: Multiplan Medicare/VA |
$55.42
|
| Rate for Payer: One Health Plan of WY PPO |
$315.56
|
| Rate for Payer: PacificSource Commercial |
$289.80
|
| Rate for Payer: PHCS PPO |
$305.90
|
| Rate for Payer: Three Rivers PPO |
$241.50
|
| Rate for Payer: TriWest Veterans Administration |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$280.14
|
| Rate for Payer: United Healthcare Medicare |
$65.20
|
| Rate for Payer: WINHealth Partners Commercial |
$273.70
|
|
|
BONE MARROW NEEDLE VORTEX 13G CLOSED
|
Facility
|
IP
|
$919.80
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.71 |
| Max. Negotiated Rate |
$919.80 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$901.40
|
| Rate for Payer: Altius Auto/Workers Compensation |
$883.01
|
| Rate for Payer: Altius Commercial |
$883.01
|
| Rate for Payer: Beech Street Commercial |
$901.40
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$755.16
|
| Rate for Payer: Cash Price |
$643.86
|
| Rate for Payer: ChoiceCare Network Commercial |
$892.21
|
| Rate for Payer: Cigna of WY Commercial |
$901.40
|
| Rate for Payer: Entrust Commercial |
$873.81
|
| Rate for Payer: First Choice Health Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$873.81
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$607.07
|
| Rate for Payer: HealthUtah PPO |
$919.80
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$892.21
|
| Rate for Payer: Multiplan Medicare/VA |
$576.71
|
| Rate for Payer: One Health Plan of WY PPO |
$901.40
|
| Rate for Payer: PacificSource Commercial |
$827.82
|
| Rate for Payer: PHCS PPO |
$901.40
|
| Rate for Payer: Three Rivers PPO |
$689.85
|
| Rate for Payer: TriWest Veterans Administration |
$607.07
|
| Rate for Payer: United Healthcare Commercial |
$800.23
|
| Rate for Payer: United Healthcare Medicare |
$607.07
|
| Rate for Payer: WINHealth Partners Commercial |
$873.81
|
| Rate for Payer: Wise Provider Network Commercial |
$873.81
|
|
