|
HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 46260
|
| Hospital Charge Code |
46260
|
| Min. Negotiated Rate |
$395.58 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,698.52
|
| Rate for Payer: Aetna of WY Medicare |
$465.39
|
| Rate for Payer: Beech Street Commercial |
$3,585.30
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,660.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,698.52
|
| Rate for Payer: First Choice Health Commercial |
$3,396.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,585.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.39
|
| Rate for Payer: HealthUtah PPO |
$3,774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,660.78
|
| Rate for Payer: Multiplan Medicare/VA |
$395.58
|
| Rate for Payer: One Health Plan of WY PPO |
$3,698.52
|
| Rate for Payer: PacificSource Commercial |
$3,396.60
|
| Rate for Payer: PHCS PPO |
$3,585.30
|
| Rate for Payer: Three Rivers PPO |
$2,830.50
|
| Rate for Payer: TriWest Veterans Administration |
$465.39
|
| Rate for Payer: United Healthcare Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Medicare |
$465.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,207.90
|
|
|
HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO
|
Professional
|
Both
|
$3,774.00
|
|
|
Service Code
|
HCPCS 46260 80
|
| Hospital Charge Code |
46260
|
| Min. Negotiated Rate |
$395.58 |
| Max. Negotiated Rate |
$3,774.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,698.52
|
| Rate for Payer: Aetna of WY Medicare |
$465.39
|
| Rate for Payer: Beech Street Commercial |
$3,585.30
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: Cash Price |
$2,641.80
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,660.78
|
| Rate for Payer: Cigna of WY Commercial |
$3,698.52
|
| Rate for Payer: First Choice Health Commercial |
$3,396.60
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,585.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$465.39
|
| Rate for Payer: HealthUtah PPO |
$3,774.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,660.78
|
| Rate for Payer: Multiplan Medicare/VA |
$395.58
|
| Rate for Payer: One Health Plan of WY PPO |
$3,698.52
|
| Rate for Payer: PacificSource Commercial |
$3,396.60
|
| Rate for Payer: PHCS PPO |
$3,585.30
|
| Rate for Payer: Three Rivers PPO |
$2,830.50
|
| Rate for Payer: TriWest Veterans Administration |
$465.39
|
| Rate for Payer: United Healthcare Commercial |
$3,283.38
|
| Rate for Payer: United Healthcare Medicare |
$465.39
|
| Rate for Payer: WINHealth Partners Commercial |
$3,207.90
|
|
|
HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP
|
Professional
|
Both
|
$4,397.00
|
|
|
Service Code
|
HCPCS 46255
|
| Hospital Charge Code |
46255
|
| Min. Negotiated Rate |
$291.61 |
| Max. Negotiated Rate |
$4,397.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$4,309.06
|
| Rate for Payer: Aetna of WY Medicare |
$343.07
|
| Rate for Payer: Beech Street Commercial |
$4,177.15
|
| Rate for Payer: Cash Price |
$3,077.90
|
| Rate for Payer: Cash Price |
$3,077.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$4,265.09
|
| Rate for Payer: Cigna of WY Commercial |
$4,309.06
|
| Rate for Payer: First Choice Health Commercial |
$3,957.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$4,177.15
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$343.07
|
| Rate for Payer: HealthUtah PPO |
$4,397.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$4,265.09
|
| Rate for Payer: Multiplan Medicare/VA |
$291.61
|
| Rate for Payer: One Health Plan of WY PPO |
$4,309.06
|
| Rate for Payer: PacificSource Commercial |
$3,957.30
|
| Rate for Payer: PHCS PPO |
$4,177.15
|
| Rate for Payer: Three Rivers PPO |
$3,297.75
|
| Rate for Payer: TriWest Veterans Administration |
$343.07
|
| Rate for Payer: United Healthcare Commercial |
$3,825.39
|
| Rate for Payer: United Healthcare Medicare |
$343.07
|
| Rate for Payer: WINHealth Partners Commercial |
$3,737.45
|
|
|
HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP
|
Professional
|
Both
|
$3,847.00
|
|
|
Service Code
|
HCPCS 46250
|
| Hospital Charge Code |
46250
|
| Min. Negotiated Rate |
$262.07 |
| Max. Negotiated Rate |
$3,847.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$3,770.06
|
| Rate for Payer: Aetna of WY Medicare |
$308.32
|
| Rate for Payer: Beech Street Commercial |
$3,654.65
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: Cash Price |
$2,692.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$3,731.59
|
| Rate for Payer: Cigna of WY Commercial |
$3,770.06
|
| Rate for Payer: First Choice Health Commercial |
$3,462.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$3,654.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$308.32
|
| Rate for Payer: HealthUtah PPO |
$3,847.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$3,731.59
|
| Rate for Payer: Multiplan Medicare/VA |
$262.07
|
| Rate for Payer: One Health Plan of WY PPO |
$3,770.06
|
| Rate for Payer: PacificSource Commercial |
$3,462.30
|
| Rate for Payer: PHCS PPO |
$3,654.65
|
| Rate for Payer: Three Rivers PPO |
$2,885.25
|
| Rate for Payer: TriWest Veterans Administration |
$308.32
|
| Rate for Payer: United Healthcare Commercial |
$3,346.89
|
| Rate for Payer: United Healthcare Medicare |
$308.32
|
| Rate for Payer: WINHealth Partners Commercial |
$3,269.95
|
|
|
HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [17950]
|
Facility
|
IP
|
$22.60
|
|
|
Service Code
|
HCPCS J1644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.17 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.70
|
| Rate for Payer: Altius Commercial |
$21.70
|
| Rate for Payer: Beech Street Commercial |
$22.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.92
|
| Rate for Payer: Cigna of WY Commercial |
$22.15
|
| Rate for Payer: Entrust Commercial |
$21.47
|
| Rate for Payer: First Choice Health Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$14.92
|
| Rate for Payer: HealthUtah PPO |
$22.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.92
|
| Rate for Payer: Multiplan Medicare/VA |
$14.17
|
| Rate for Payer: One Health Plan of WY PPO |
$22.15
|
| Rate for Payer: PacificSource Commercial |
$20.34
|
| Rate for Payer: PHCS PPO |
$22.15
|
| Rate for Payer: Three Rivers PPO |
$16.95
|
| Rate for Payer: TriWest Veterans Administration |
$14.92
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Medicare |
$14.92
|
| Rate for Payer: WINHealth Partners Commercial |
$21.47
|
| Rate for Payer: Wise Provider Network Commercial |
$21.47
|
|
|
HEPARIN (PORCINE) 10,000 UNIT/ML INJECTION SOLUTION [17950]
|
Facility
|
OP
|
$22.60
|
|
|
Service Code
|
HCPCS J1644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$22.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$22.15
|
| Rate for Payer: Aetna of WY Medicare |
$14.92
|
| Rate for Payer: Altius Auto/Workers Compensation |
$21.70
|
| Rate for Payer: Altius Commercial |
$21.70
|
| Rate for Payer: Beech Street Commercial |
$22.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$18.55
|
| Rate for Payer: Cash Price |
$15.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$21.92
|
| Rate for Payer: Cigna of WY Commercial |
$22.15
|
| Rate for Payer: Entrust Commercial |
$21.47
|
| Rate for Payer: First Choice Health Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$21.47
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$13.11
|
| Rate for Payer: HealthUtah PPO |
$22.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$21.92
|
| Rate for Payer: Multiplan Medicare/VA |
$12.45
|
| Rate for Payer: One Health Plan of WY PPO |
$22.15
|
| Rate for Payer: PacificSource Commercial |
$20.34
|
| Rate for Payer: PHCS PPO |
$22.15
|
| Rate for Payer: Three Rivers PPO |
$16.95
|
| Rate for Payer: TriWest Veterans Administration |
$13.11
|
| Rate for Payer: United Healthcare Commercial |
$19.66
|
| Rate for Payer: United Healthcare Medicare |
$13.11
|
| Rate for Payer: WINHealth Partners Commercial |
$22.15
|
| Rate for Payer: Wise Provider Network Commercial |
$21.47
|
|
|
HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [2125]
|
Facility
|
OP
|
$17.91
|
|
|
Service Code
|
NDC 6332354005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.87 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.55
|
| Rate for Payer: Aetna of WY Medicare |
$11.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.19
|
| Rate for Payer: Altius Commercial |
$17.19
|
| Rate for Payer: Beech Street Commercial |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.37
|
| Rate for Payer: Cigna of WY Commercial |
$17.55
|
| Rate for Payer: Entrust Commercial |
$17.01
|
| Rate for Payer: First Choice Health Commercial |
$17.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.39
|
| Rate for Payer: HealthUtah PPO |
$17.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.37
|
| Rate for Payer: Multiplan Medicare/VA |
$9.87
|
| Rate for Payer: One Health Plan of WY PPO |
$17.55
|
| Rate for Payer: PacificSource Commercial |
$16.12
|
| Rate for Payer: PHCS PPO |
$17.55
|
| Rate for Payer: Three Rivers PPO |
$13.43
|
| Rate for Payer: TriWest Veterans Administration |
$10.39
|
| Rate for Payer: United Healthcare Commercial |
$15.58
|
| Rate for Payer: United Healthcare Medicare |
$10.39
|
| Rate for Payer: WINHealth Partners Commercial |
$17.55
|
| Rate for Payer: Wise Provider Network Commercial |
$17.01
|
|
|
HEPARIN (PORCINE) 1,000 UNIT/ML INJECTION SOLUTION [2125]
|
Facility
|
IP
|
$17.91
|
|
|
Service Code
|
NDC 6332354005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.23 |
| Max. Negotiated Rate |
$17.91 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$17.55
|
| Rate for Payer: Altius Auto/Workers Compensation |
$17.19
|
| Rate for Payer: Altius Commercial |
$17.19
|
| Rate for Payer: Beech Street Commercial |
$17.55
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$14.70
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: ChoiceCare Network Commercial |
$17.37
|
| Rate for Payer: Cigna of WY Commercial |
$17.55
|
| Rate for Payer: Entrust Commercial |
$17.01
|
| Rate for Payer: First Choice Health Commercial |
$17.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$17.01
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$11.82
|
| Rate for Payer: HealthUtah PPO |
$17.91
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$17.37
|
| Rate for Payer: Multiplan Medicare/VA |
$11.23
|
| Rate for Payer: One Health Plan of WY PPO |
$17.55
|
| Rate for Payer: PacificSource Commercial |
$16.12
|
| Rate for Payer: PHCS PPO |
$17.55
|
| Rate for Payer: Three Rivers PPO |
$13.43
|
| Rate for Payer: TriWest Veterans Administration |
$11.82
|
| Rate for Payer: United Healthcare Commercial |
$15.58
|
| Rate for Payer: United Healthcare Medicare |
$11.82
|
| Rate for Payer: WINHealth Partners Commercial |
$17.01
|
| Rate for Payer: Wise Provider Network Commercial |
$17.01
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [40789]
|
Facility
|
OP
|
$0.25
|
|
|
Service Code
|
NDC 0264958720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.14 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Aetna of WY Medicare |
$0.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.24
|
| Rate for Payer: Altius Commercial |
$0.24
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.24
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.24
|
| Rate for Payer: First Choice Health Commercial |
$0.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.15
|
| Rate for Payer: HealthUtah PPO |
$0.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.14
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.19
|
| Rate for Payer: TriWest Veterans Administration |
$0.15
|
| Rate for Payer: United Healthcare Commercial |
$0.22
|
| Rate for Payer: United Healthcare Medicare |
$0.15
|
| Rate for Payer: WINHealth Partners Commercial |
$0.25
|
| Rate for Payer: Wise Provider Network Commercial |
$0.24
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [40789]
|
Facility
|
OP
|
$0.18
|
|
|
Service Code
|
NDC 0409452002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Aetna of WY Medicare |
$0.12
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.10
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.10
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.10
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.10
|
| Rate for Payer: WINHealth Partners Commercial |
$0.18
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [40789]
|
Facility
|
IP
|
$0.25
|
|
|
Service Code
|
NDC 0264958720
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.16 |
| Max. Negotiated Rate |
$0.25 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.24
|
| Rate for Payer: Altius Commercial |
$0.24
|
| Rate for Payer: Beech Street Commercial |
$0.25
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.24
|
| Rate for Payer: Cigna of WY Commercial |
$0.25
|
| Rate for Payer: Entrust Commercial |
$0.24
|
| Rate for Payer: First Choice Health Commercial |
$0.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.24
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.17
|
| Rate for Payer: HealthUtah PPO |
$0.25
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.24
|
| Rate for Payer: Multiplan Medicare/VA |
$0.16
|
| Rate for Payer: One Health Plan of WY PPO |
$0.25
|
| Rate for Payer: PacificSource Commercial |
$0.23
|
| Rate for Payer: PHCS PPO |
$0.25
|
| Rate for Payer: Three Rivers PPO |
$0.19
|
| Rate for Payer: TriWest Veterans Administration |
$0.17
|
| Rate for Payer: United Healthcare Commercial |
$0.22
|
| Rate for Payer: United Healthcare Medicare |
$0.17
|
| Rate for Payer: WINHealth Partners Commercial |
$0.24
|
| Rate for Payer: Wise Provider Network Commercial |
$0.24
|
|
|
HEPARIN (PORCINE) 25,000 UNIT/250 ML (100 UNIT/ML) IN DEXTROSE 5 % IV [40789]
|
Facility
|
IP
|
$0.18
|
|
|
Service Code
|
NDC 0409452002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.18 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$0.18
|
| Rate for Payer: Altius Auto/Workers Compensation |
$0.17
|
| Rate for Payer: Altius Commercial |
$0.17
|
| Rate for Payer: Beech Street Commercial |
$0.18
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$0.15
|
| Rate for Payer: Cash Price |
$0.12
|
| Rate for Payer: ChoiceCare Network Commercial |
$0.17
|
| Rate for Payer: Cigna of WY Commercial |
$0.18
|
| Rate for Payer: Entrust Commercial |
$0.17
|
| Rate for Payer: First Choice Health Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$0.17
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$0.12
|
| Rate for Payer: HealthUtah PPO |
$0.18
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$0.17
|
| Rate for Payer: Multiplan Medicare/VA |
$0.11
|
| Rate for Payer: One Health Plan of WY PPO |
$0.18
|
| Rate for Payer: PacificSource Commercial |
$0.16
|
| Rate for Payer: PHCS PPO |
$0.18
|
| Rate for Payer: Three Rivers PPO |
$0.14
|
| Rate for Payer: TriWest Veterans Administration |
$0.12
|
| Rate for Payer: United Healthcare Commercial |
$0.16
|
| Rate for Payer: United Healthcare Medicare |
$0.12
|
| Rate for Payer: WINHealth Partners Commercial |
$0.17
|
| Rate for Payer: Wise Provider Network Commercial |
$0.17
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [19030]
|
Facility
|
OP
|
$30.60
|
|
|
Service Code
|
HCPCS J1644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.86 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.99
|
| Rate for Payer: Aetna of WY Medicare |
$20.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.38
|
| Rate for Payer: Altius Commercial |
$29.38
|
| Rate for Payer: Beech Street Commercial |
$29.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.12
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.68
|
| Rate for Payer: Cigna of WY Commercial |
$29.99
|
| Rate for Payer: Entrust Commercial |
$29.07
|
| Rate for Payer: First Choice Health Commercial |
$29.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$17.75
|
| Rate for Payer: HealthUtah PPO |
$30.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.68
|
| Rate for Payer: Multiplan Medicare/VA |
$16.86
|
| Rate for Payer: One Health Plan of WY PPO |
$29.99
|
| Rate for Payer: PacificSource Commercial |
$27.54
|
| Rate for Payer: PHCS PPO |
$29.99
|
| Rate for Payer: Three Rivers PPO |
$22.95
|
| Rate for Payer: TriWest Veterans Administration |
$17.75
|
| Rate for Payer: United Healthcare Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare |
$17.75
|
| Rate for Payer: WINHealth Partners Commercial |
$29.99
|
| Rate for Payer: Wise Provider Network Commercial |
$29.07
|
|
|
HEPARIN (PORCINE) 5,000 UNIT/ML INJECTION SOLUTION [19030]
|
Facility
|
IP
|
$30.60
|
|
|
Service Code
|
HCPCS J1644
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.19 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$29.99
|
| Rate for Payer: Altius Auto/Workers Compensation |
$29.38
|
| Rate for Payer: Altius Commercial |
$29.38
|
| Rate for Payer: Beech Street Commercial |
$29.99
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$25.12
|
| Rate for Payer: Cash Price |
$21.42
|
| Rate for Payer: ChoiceCare Network Commercial |
$29.68
|
| Rate for Payer: Cigna of WY Commercial |
$29.99
|
| Rate for Payer: Entrust Commercial |
$29.07
|
| Rate for Payer: First Choice Health Commercial |
$29.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$29.07
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$20.20
|
| Rate for Payer: HealthUtah PPO |
$30.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$29.68
|
| Rate for Payer: Multiplan Medicare/VA |
$19.19
|
| Rate for Payer: One Health Plan of WY PPO |
$29.99
|
| Rate for Payer: PacificSource Commercial |
$27.54
|
| Rate for Payer: PHCS PPO |
$29.99
|
| Rate for Payer: Three Rivers PPO |
$22.95
|
| Rate for Payer: TriWest Veterans Administration |
$20.20
|
| Rate for Payer: United Healthcare Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare |
$20.20
|
| Rate for Payer: WINHealth Partners Commercial |
$29.07
|
| Rate for Payer: Wise Provider Network Commercial |
$29.07
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [40790]
|
Facility
|
IP
|
$15.53
|
|
|
Service Code
|
NDC 6425333335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.91
|
| Rate for Payer: Altius Commercial |
$14.91
|
| Rate for Payer: Beech Street Commercial |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.06
|
| Rate for Payer: Cigna of WY Commercial |
$15.22
|
| Rate for Payer: Entrust Commercial |
$14.75
|
| Rate for Payer: First Choice Health Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.25
|
| Rate for Payer: HealthUtah PPO |
$15.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.06
|
| Rate for Payer: Multiplan Medicare/VA |
$9.74
|
| Rate for Payer: One Health Plan of WY PPO |
$15.22
|
| Rate for Payer: PacificSource Commercial |
$13.98
|
| Rate for Payer: PHCS PPO |
$15.22
|
| Rate for Payer: Three Rivers PPO |
$11.65
|
| Rate for Payer: TriWest Veterans Administration |
$10.25
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
| Rate for Payer: United Healthcare Medicare |
$10.25
|
| Rate for Payer: WINHealth Partners Commercial |
$14.75
|
| Rate for Payer: Wise Provider Network Commercial |
$14.75
|
|
|
HEPARIN, PORCINE (PF) 100 UNIT/ML INTRAVENOUS SYRINGE [40790]
|
Facility
|
OP
|
$15.53
|
|
|
Service Code
|
NDC 6425333335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.56 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.22
|
| Rate for Payer: Aetna of WY Medicare |
$10.25
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.91
|
| Rate for Payer: Altius Commercial |
$14.91
|
| Rate for Payer: Beech Street Commercial |
$15.22
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.75
|
| Rate for Payer: Cash Price |
$10.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.06
|
| Rate for Payer: Cigna of WY Commercial |
$15.22
|
| Rate for Payer: Entrust Commercial |
$14.75
|
| Rate for Payer: First Choice Health Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.75
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$9.01
|
| Rate for Payer: HealthUtah PPO |
$15.53
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.06
|
| Rate for Payer: Multiplan Medicare/VA |
$8.56
|
| Rate for Payer: One Health Plan of WY PPO |
$15.22
|
| Rate for Payer: PacificSource Commercial |
$13.98
|
| Rate for Payer: PHCS PPO |
$15.22
|
| Rate for Payer: Three Rivers PPO |
$11.65
|
| Rate for Payer: TriWest Veterans Administration |
$9.01
|
| Rate for Payer: United Healthcare Commercial |
$13.51
|
| Rate for Payer: United Healthcare Medicare |
$9.01
|
| Rate for Payer: WINHealth Partners Commercial |
$15.22
|
| Rate for Payer: Wise Provider Network Commercial |
$14.75
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [40791]
|
Facility
|
OP
|
$15.46
|
|
|
Service Code
|
NDC 8290306414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Aetna of WY Medicare |
$10.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.97
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$8.52
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$8.97
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$8.97
|
| Rate for Payer: WINHealth Partners Commercial |
$15.15
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [40791]
|
Facility
|
IP
|
$15.46
|
|
|
Service Code
|
NDC 8290306414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.69 |
| Max. Negotiated Rate |
$15.46 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.84
|
| Rate for Payer: Altius Commercial |
$14.84
|
| Rate for Payer: Beech Street Commercial |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.69
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.00
|
| Rate for Payer: Cigna of WY Commercial |
$15.15
|
| Rate for Payer: Entrust Commercial |
$14.69
|
| Rate for Payer: First Choice Health Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.69
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.20
|
| Rate for Payer: HealthUtah PPO |
$15.46
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.00
|
| Rate for Payer: Multiplan Medicare/VA |
$9.69
|
| Rate for Payer: One Health Plan of WY PPO |
$15.15
|
| Rate for Payer: PacificSource Commercial |
$13.91
|
| Rate for Payer: PHCS PPO |
$15.15
|
| Rate for Payer: Three Rivers PPO |
$11.60
|
| Rate for Payer: TriWest Veterans Administration |
$10.20
|
| Rate for Payer: United Healthcare Commercial |
$13.45
|
| Rate for Payer: United Healthcare Medicare |
$10.20
|
| Rate for Payer: WINHealth Partners Commercial |
$14.69
|
| Rate for Payer: Wise Provider Network Commercial |
$14.69
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [40791]
|
Facility
|
OP
|
$15.48
|
|
|
Service Code
|
NDC 6425322235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Aetna of WY Medicare |
$10.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$8.98
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$8.53
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$8.98
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$8.98
|
| Rate for Payer: WINHealth Partners Commercial |
$15.17
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
HEPARIN, PORCINE (PF) 10 UNIT/ML INTRAVENOUS SYRINGE [40791]
|
Facility
|
IP
|
$15.48
|
|
|
Service Code
|
NDC 6425322235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$15.48 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$15.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$14.86
|
| Rate for Payer: Altius Commercial |
$14.86
|
| Rate for Payer: Beech Street Commercial |
$15.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$12.71
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: ChoiceCare Network Commercial |
$15.02
|
| Rate for Payer: Cigna of WY Commercial |
$15.17
|
| Rate for Payer: Entrust Commercial |
$14.71
|
| Rate for Payer: First Choice Health Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$14.71
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$10.22
|
| Rate for Payer: HealthUtah PPO |
$15.48
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$15.02
|
| Rate for Payer: Multiplan Medicare/VA |
$9.71
|
| Rate for Payer: One Health Plan of WY PPO |
$15.17
|
| Rate for Payer: PacificSource Commercial |
$13.93
|
| Rate for Payer: PHCS PPO |
$15.17
|
| Rate for Payer: Three Rivers PPO |
$11.61
|
| Rate for Payer: TriWest Veterans Administration |
$10.22
|
| Rate for Payer: United Healthcare Commercial |
$13.47
|
| Rate for Payer: United Healthcare Medicare |
$10.22
|
| Rate for Payer: WINHealth Partners Commercial |
$14.71
|
| Rate for Payer: Wise Provider Network Commercial |
$14.71
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [44133]
|
Facility
|
IP
|
$211.40
|
|
|
Service Code
|
NDC 5816081552
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$202.94
|
| Rate for Payer: Altius Commercial |
$202.94
|
| Rate for Payer: Beech Street Commercial |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.56
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.06
|
| Rate for Payer: Cigna of WY Commercial |
$207.17
|
| Rate for Payer: Entrust Commercial |
$200.83
|
| Rate for Payer: First Choice Health Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.52
|
| Rate for Payer: HealthUtah PPO |
$211.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.06
|
| Rate for Payer: Multiplan Medicare/VA |
$132.55
|
| Rate for Payer: One Health Plan of WY PPO |
$207.17
|
| Rate for Payer: PacificSource Commercial |
$190.26
|
| Rate for Payer: PHCS PPO |
$207.17
|
| Rate for Payer: Three Rivers PPO |
$158.55
|
| Rate for Payer: TriWest Veterans Administration |
$139.52
|
| Rate for Payer: United Healthcare Commercial |
$183.92
|
| Rate for Payer: United Healthcare Medicare |
$139.52
|
| Rate for Payer: WINHealth Partners Commercial |
$200.83
|
| Rate for Payer: Wise Provider Network Commercial |
$200.83
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [44133]
|
Facility
|
OP
|
$211.40
|
|
|
Service Code
|
NDC 5816081543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.17
|
| Rate for Payer: Aetna of WY Medicare |
$139.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$202.94
|
| Rate for Payer: Altius Commercial |
$202.94
|
| Rate for Payer: Beech Street Commercial |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.56
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.06
|
| Rate for Payer: Cigna of WY Commercial |
$207.17
|
| Rate for Payer: Entrust Commercial |
$200.83
|
| Rate for Payer: First Choice Health Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.61
|
| Rate for Payer: HealthUtah PPO |
$211.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.06
|
| Rate for Payer: Multiplan Medicare/VA |
$116.48
|
| Rate for Payer: One Health Plan of WY PPO |
$207.17
|
| Rate for Payer: PacificSource Commercial |
$190.26
|
| Rate for Payer: PHCS PPO |
$207.17
|
| Rate for Payer: Three Rivers PPO |
$158.55
|
| Rate for Payer: TriWest Veterans Administration |
$122.61
|
| Rate for Payer: United Healthcare Commercial |
$183.92
|
| Rate for Payer: United Healthcare Medicare |
$122.61
|
| Rate for Payer: WINHealth Partners Commercial |
$207.17
|
| Rate for Payer: Wise Provider Network Commercial |
$200.83
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [44133]
|
Facility
|
IP
|
$211.40
|
|
|
Service Code
|
NDC 5816081543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$132.55 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.17
|
| Rate for Payer: Altius Auto/Workers Compensation |
$202.94
|
| Rate for Payer: Altius Commercial |
$202.94
|
| Rate for Payer: Beech Street Commercial |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.56
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.06
|
| Rate for Payer: Cigna of WY Commercial |
$207.17
|
| Rate for Payer: Entrust Commercial |
$200.83
|
| Rate for Payer: First Choice Health Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.52
|
| Rate for Payer: HealthUtah PPO |
$211.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.06
|
| Rate for Payer: Multiplan Medicare/VA |
$132.55
|
| Rate for Payer: One Health Plan of WY PPO |
$207.17
|
| Rate for Payer: PacificSource Commercial |
$190.26
|
| Rate for Payer: PHCS PPO |
$207.17
|
| Rate for Payer: Three Rivers PPO |
$158.55
|
| Rate for Payer: TriWest Veterans Administration |
$139.52
|
| Rate for Payer: United Healthcare Commercial |
$183.92
|
| Rate for Payer: United Healthcare Medicare |
$139.52
|
| Rate for Payer: WINHealth Partners Commercial |
$200.83
|
| Rate for Payer: Wise Provider Network Commercial |
$200.83
|
|
|
HEPATITIS A AND B VIRUS VACCINE(PF)720 ELISA UNIT-20 MCG/ML IM SYRINGE [44133]
|
Facility
|
OP
|
$211.40
|
|
|
Service Code
|
NDC 5816081552
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.48 |
| Max. Negotiated Rate |
$211.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$207.17
|
| Rate for Payer: Aetna of WY Medicare |
$139.52
|
| Rate for Payer: Altius Auto/Workers Compensation |
$202.94
|
| Rate for Payer: Altius Commercial |
$202.94
|
| Rate for Payer: Beech Street Commercial |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$173.56
|
| Rate for Payer: Cash Price |
$147.98
|
| Rate for Payer: ChoiceCare Network Commercial |
$205.06
|
| Rate for Payer: Cigna of WY Commercial |
$207.17
|
| Rate for Payer: Entrust Commercial |
$200.83
|
| Rate for Payer: First Choice Health Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$200.83
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$122.61
|
| Rate for Payer: HealthUtah PPO |
$211.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$205.06
|
| Rate for Payer: Multiplan Medicare/VA |
$116.48
|
| Rate for Payer: One Health Plan of WY PPO |
$207.17
|
| Rate for Payer: PacificSource Commercial |
$190.26
|
| Rate for Payer: PHCS PPO |
$207.17
|
| Rate for Payer: Three Rivers PPO |
$158.55
|
| Rate for Payer: TriWest Veterans Administration |
$122.61
|
| Rate for Payer: United Healthcare Commercial |
$183.92
|
| Rate for Payer: United Healthcare Medicare |
$122.61
|
| Rate for Payer: WINHealth Partners Commercial |
$207.17
|
| Rate for Payer: Wise Provider Network Commercial |
$200.83
|
|
|
HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 90636
|
| Hospital Charge Code |
90636
|
| Min. Negotiated Rate |
$314.25 |
| Max. Negotiated Rate |
$419.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$410.62
|
| Rate for Payer: Beech Street Commercial |
$398.05
|
| Rate for Payer: Cash Price |
$293.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$406.43
|
| Rate for Payer: Cigna of WY Commercial |
$410.62
|
| Rate for Payer: First Choice Health Commercial |
$377.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$398.05
|
| Rate for Payer: HealthUtah PPO |
$419.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$406.43
|
| Rate for Payer: One Health Plan of WY PPO |
$410.62
|
| Rate for Payer: PacificSource Commercial |
$377.10
|
| Rate for Payer: PHCS PPO |
$398.05
|
| Rate for Payer: Three Rivers PPO |
$314.25
|
| Rate for Payer: United Healthcare Commercial |
$364.53
|
| Rate for Payer: WINHealth Partners Commercial |
$419.00
|
|
