|
HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 99234
|
| Hospital Charge Code |
99234
|
| Min. Negotiated Rate |
$79.48 |
| Max. Negotiated Rate |
$312.62 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$312.62
|
| Rate for Payer: Aetna of WY Medicare |
$93.51
|
| Rate for Payer: Beech Street Commercial |
$303.05
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: ChoiceCare Network Commercial |
$309.43
|
| Rate for Payer: Cigna of WY Commercial |
$312.62
|
| Rate for Payer: First Choice Health Commercial |
$287.10
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$303.05
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$93.51
|
| Rate for Payer: HealthUtah PPO |
$165.34
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$309.43
|
| Rate for Payer: Multiplan Medicare/VA |
$79.48
|
| Rate for Payer: One Health Plan of WY PPO |
$312.62
|
| Rate for Payer: PacificSource Commercial |
$287.10
|
| Rate for Payer: PHCS PPO |
$303.05
|
| Rate for Payer: Three Rivers PPO |
$239.25
|
| Rate for Payer: TriWest Veterans Administration |
$93.51
|
| Rate for Payer: United Healthcare Commercial |
$277.53
|
| Rate for Payer: United Healthcare Medicare |
$93.51
|
| Rate for Payer: WINHealth Partners Commercial |
$303.05
|
|
|
HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 99239
|
| Hospital Charge Code |
99239
|
| Min. Negotiated Rate |
$93.54 |
| Max. Negotiated Rate |
$235.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$235.20
|
| Rate for Payer: Aetna of WY Medicare |
$110.05
|
| Rate for Payer: Beech Street Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.80
|
| Rate for Payer: Cigna of WY Commercial |
$235.20
|
| Rate for Payer: First Choice Health Commercial |
$216.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$228.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$110.05
|
| Rate for Payer: HealthUtah PPO |
$115.60
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.80
|
| Rate for Payer: Multiplan Medicare/VA |
$93.54
|
| Rate for Payer: One Health Plan of WY PPO |
$235.20
|
| Rate for Payer: PacificSource Commercial |
$216.00
|
| Rate for Payer: PHCS PPO |
$228.00
|
| Rate for Payer: Three Rivers PPO |
$180.00
|
| Rate for Payer: TriWest Veterans Administration |
$110.05
|
| Rate for Payer: United Healthcare Commercial |
$208.80
|
| Rate for Payer: United Healthcare Medicare |
$110.05
|
| Rate for Payer: WINHealth Partners Commercial |
$228.00
|
|
|
HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 99238
|
| Hospital Charge Code |
99238
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$186.20
|
| Rate for Payer: Aetna of WY Medicare |
$77.97
|
| Rate for Payer: Beech Street Commercial |
$180.50
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: Cash Price |
$133.00
|
| Rate for Payer: ChoiceCare Network Commercial |
$184.30
|
| Rate for Payer: Cigna of WY Commercial |
$186.20
|
| Rate for Payer: First Choice Health Commercial |
$171.00
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$180.50
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$77.97
|
| Rate for Payer: HealthUtah PPO |
$84.24
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$184.30
|
| Rate for Payer: Multiplan Medicare/VA |
$66.27
|
| Rate for Payer: One Health Plan of WY PPO |
$186.20
|
| Rate for Payer: PacificSource Commercial |
$171.00
|
| Rate for Payer: PHCS PPO |
$180.50
|
| Rate for Payer: Three Rivers PPO |
$142.50
|
| Rate for Payer: TriWest Veterans Administration |
$77.97
|
| Rate for Payer: United Healthcare Commercial |
$165.30
|
| Rate for Payer: United Healthcare Medicare |
$77.97
|
| Rate for Payer: WINHealth Partners Commercial |
$180.50
|
|
|
HOTLINE FLUID WARMER SET L70
|
Facility
|
IP
|
$33.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$33.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.73
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.06
|
| Rate for Payer: Altius Commercial |
$32.06
|
| Rate for Payer: Beech Street Commercial |
$32.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.40
|
| Rate for Payer: Cigna of WY Commercial |
$32.73
|
| Rate for Payer: Entrust Commercial |
$31.73
|
| Rate for Payer: First Choice Health Commercial |
$31.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$22.04
|
| Rate for Payer: HealthUtah PPO |
$33.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.40
|
| Rate for Payer: Multiplan Medicare/VA |
$20.94
|
| Rate for Payer: One Health Plan of WY PPO |
$32.73
|
| Rate for Payer: PacificSource Commercial |
$30.06
|
| Rate for Payer: PHCS PPO |
$32.73
|
| Rate for Payer: Three Rivers PPO |
$25.05
|
| Rate for Payer: TriWest Veterans Administration |
$22.04
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare |
$22.04
|
| Rate for Payer: WINHealth Partners Commercial |
$31.73
|
| Rate for Payer: Wise Provider Network Commercial |
$31.73
|
|
|
HOTLINE FLUID WARMER SET L70
|
Facility
|
OP
|
$33.40
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$33.40 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$32.73
|
| Rate for Payer: Aetna of WY Medicare |
$22.04
|
| Rate for Payer: Altius Auto/Workers Compensation |
$32.06
|
| Rate for Payer: Altius Commercial |
$32.06
|
| Rate for Payer: Beech Street Commercial |
$32.73
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$27.42
|
| Rate for Payer: Cash Price |
$23.38
|
| Rate for Payer: ChoiceCare Network Commercial |
$32.40
|
| Rate for Payer: Cigna of WY Commercial |
$32.73
|
| Rate for Payer: Entrust Commercial |
$31.73
|
| Rate for Payer: First Choice Health Commercial |
$31.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$31.73
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$19.37
|
| Rate for Payer: HealthUtah PPO |
$33.40
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$32.40
|
| Rate for Payer: Multiplan Medicare/VA |
$18.40
|
| Rate for Payer: One Health Plan of WY PPO |
$32.73
|
| Rate for Payer: PacificSource Commercial |
$30.06
|
| Rate for Payer: PHCS PPO |
$32.73
|
| Rate for Payer: Three Rivers PPO |
$25.05
|
| Rate for Payer: TriWest Veterans Administration |
$19.37
|
| Rate for Payer: United Healthcare Commercial |
$29.06
|
| Rate for Payer: United Healthcare Medicare |
$19.37
|
| Rate for Payer: WINHealth Partners Commercial |
$32.73
|
| Rate for Payer: Wise Provider Network Commercial |
$31.73
|
|
|
HOVERMATT SPU 34X78" HM34SPU-B
|
Facility
|
OP
|
$239.73
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$132.09 |
| Max. Negotiated Rate |
$239.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.94
|
| Rate for Payer: Aetna of WY Medicare |
$158.22
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.14
|
| Rate for Payer: Altius Commercial |
$230.14
|
| Rate for Payer: Beech Street Commercial |
$234.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.82
|
| Rate for Payer: Cash Price |
$167.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.54
|
| Rate for Payer: Cigna of WY Commercial |
$234.94
|
| Rate for Payer: Entrust Commercial |
$227.74
|
| Rate for Payer: First Choice Health Commercial |
$227.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$139.04
|
| Rate for Payer: HealthUtah PPO |
$239.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.54
|
| Rate for Payer: Multiplan Medicare/VA |
$132.09
|
| Rate for Payer: One Health Plan of WY PPO |
$234.94
|
| Rate for Payer: PacificSource Commercial |
$215.76
|
| Rate for Payer: PHCS PPO |
$234.94
|
| Rate for Payer: Three Rivers PPO |
$179.80
|
| Rate for Payer: TriWest Veterans Administration |
$139.04
|
| Rate for Payer: United Healthcare Commercial |
$208.57
|
| Rate for Payer: United Healthcare Medicare |
$139.04
|
| Rate for Payer: WINHealth Partners Commercial |
$234.94
|
| Rate for Payer: Wise Provider Network Commercial |
$227.74
|
|
|
HOVERMATT SPU 34X78" HM34SPU-B
|
Facility
|
IP
|
$239.73
|
|
| Hospital Charge Code |
27000000S1
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$150.31 |
| Max. Negotiated Rate |
$239.73 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$234.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$230.14
|
| Rate for Payer: Altius Commercial |
$230.14
|
| Rate for Payer: Beech Street Commercial |
$234.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$196.82
|
| Rate for Payer: Cash Price |
$167.81
|
| Rate for Payer: ChoiceCare Network Commercial |
$232.54
|
| Rate for Payer: Cigna of WY Commercial |
$234.94
|
| Rate for Payer: Entrust Commercial |
$227.74
|
| Rate for Payer: First Choice Health Commercial |
$227.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$227.74
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$158.22
|
| Rate for Payer: HealthUtah PPO |
$239.73
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$232.54
|
| Rate for Payer: Multiplan Medicare/VA |
$150.31
|
| Rate for Payer: One Health Plan of WY PPO |
$234.94
|
| Rate for Payer: PacificSource Commercial |
$215.76
|
| Rate for Payer: PHCS PPO |
$234.94
|
| Rate for Payer: Three Rivers PPO |
$179.80
|
| Rate for Payer: TriWest Veterans Administration |
$158.22
|
| Rate for Payer: United Healthcare Commercial |
$208.57
|
| Rate for Payer: United Healthcare Medicare |
$158.22
|
| Rate for Payer: WINHealth Partners Commercial |
$227.74
|
| Rate for Payer: Wise Provider Network Commercial |
$227.74
|
|
|
HO W/O JOINTS CF
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
HCPCS L3919
|
| Hospital Charge Code |
L3919
|
| Min. Negotiated Rate |
$249.22 |
| Max. Negotiated Rate |
$402.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$393.96
|
| Rate for Payer: Aetna of WY Medicare |
$293.20
|
| Rate for Payer: Beech Street Commercial |
$381.90
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: ChoiceCare Network Commercial |
$389.94
|
| Rate for Payer: Cigna of WY Commercial |
$393.96
|
| Rate for Payer: First Choice Health Commercial |
$361.80
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$381.90
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$293.20
|
| Rate for Payer: HealthUtah PPO |
$402.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$389.94
|
| Rate for Payer: Multiplan Medicare/VA |
$249.22
|
| Rate for Payer: One Health Plan of WY PPO |
$393.96
|
| Rate for Payer: PacificSource Commercial |
$361.80
|
| Rate for Payer: PHCS PPO |
$381.90
|
| Rate for Payer: Three Rivers PPO |
$301.50
|
| Rate for Payer: TriWest Veterans Administration |
$293.20
|
| Rate for Payer: United Healthcare Commercial |
$349.74
|
| Rate for Payer: United Healthcare Medicare |
$293.20
|
| Rate for Payer: WINHealth Partners Commercial |
$381.90
|
|
|
HSG CATHETER KRATON 5FR
|
Facility
|
OP
|
$92.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.82
|
| Rate for Payer: Aetna of WY Medicare |
$61.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.96
|
| Rate for Payer: Altius Commercial |
$88.96
|
| Rate for Payer: Beech Street Commercial |
$90.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.08
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.89
|
| Rate for Payer: Cigna of WY Commercial |
$90.82
|
| Rate for Payer: Entrust Commercial |
$88.04
|
| Rate for Payer: First Choice Health Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.75
|
| Rate for Payer: HealthUtah PPO |
$92.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.89
|
| Rate for Payer: Multiplan Medicare/VA |
$51.06
|
| Rate for Payer: One Health Plan of WY PPO |
$90.82
|
| Rate for Payer: PacificSource Commercial |
$83.40
|
| Rate for Payer: PHCS PPO |
$90.82
|
| Rate for Payer: Three Rivers PPO |
$69.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.75
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicare |
$53.75
|
| Rate for Payer: WINHealth Partners Commercial |
$90.82
|
| Rate for Payer: Wise Provider Network Commercial |
$88.04
|
|
|
HSG CATHETER KRATON 5FR
|
Facility
|
IP
|
$92.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.96
|
| Rate for Payer: Altius Commercial |
$88.96
|
| Rate for Payer: Beech Street Commercial |
$90.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.08
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.89
|
| Rate for Payer: Cigna of WY Commercial |
$90.82
|
| Rate for Payer: Entrust Commercial |
$88.04
|
| Rate for Payer: First Choice Health Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.16
|
| Rate for Payer: HealthUtah PPO |
$92.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.89
|
| Rate for Payer: Multiplan Medicare/VA |
$58.10
|
| Rate for Payer: One Health Plan of WY PPO |
$90.82
|
| Rate for Payer: PacificSource Commercial |
$83.40
|
| Rate for Payer: PHCS PPO |
$90.82
|
| Rate for Payer: Three Rivers PPO |
$69.50
|
| Rate for Payer: TriWest Veterans Administration |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicare |
$61.16
|
| Rate for Payer: WINHealth Partners Commercial |
$88.04
|
| Rate for Payer: Wise Provider Network Commercial |
$88.04
|
|
|
HSG CATHETER KRATON 7FR
|
Facility
|
OP
|
$92.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.06 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.82
|
| Rate for Payer: Aetna of WY Medicare |
$61.16
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.96
|
| Rate for Payer: Altius Commercial |
$88.96
|
| Rate for Payer: Beech Street Commercial |
$90.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.08
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.89
|
| Rate for Payer: Cigna of WY Commercial |
$90.82
|
| Rate for Payer: Entrust Commercial |
$88.04
|
| Rate for Payer: First Choice Health Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$53.75
|
| Rate for Payer: HealthUtah PPO |
$92.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.89
|
| Rate for Payer: Multiplan Medicare/VA |
$51.06
|
| Rate for Payer: One Health Plan of WY PPO |
$90.82
|
| Rate for Payer: PacificSource Commercial |
$83.40
|
| Rate for Payer: PHCS PPO |
$90.82
|
| Rate for Payer: Three Rivers PPO |
$69.50
|
| Rate for Payer: TriWest Veterans Administration |
$53.75
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicare |
$53.75
|
| Rate for Payer: WINHealth Partners Commercial |
$90.82
|
| Rate for Payer: Wise Provider Network Commercial |
$88.04
|
|
|
HSG CATHETER KRATON 7FR
|
Facility
|
IP
|
$92.67
|
|
| Hospital Charge Code |
27200000S1
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$90.82
|
| Rate for Payer: Altius Auto/Workers Compensation |
$88.96
|
| Rate for Payer: Altius Commercial |
$88.96
|
| Rate for Payer: Beech Street Commercial |
$90.82
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$76.08
|
| Rate for Payer: Cash Price |
$64.87
|
| Rate for Payer: ChoiceCare Network Commercial |
$89.89
|
| Rate for Payer: Cigna of WY Commercial |
$90.82
|
| Rate for Payer: Entrust Commercial |
$88.04
|
| Rate for Payer: First Choice Health Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$88.04
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$61.16
|
| Rate for Payer: HealthUtah PPO |
$92.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$89.89
|
| Rate for Payer: Multiplan Medicare/VA |
$58.10
|
| Rate for Payer: One Health Plan of WY PPO |
$90.82
|
| Rate for Payer: PacificSource Commercial |
$83.40
|
| Rate for Payer: PHCS PPO |
$90.82
|
| Rate for Payer: Three Rivers PPO |
$69.50
|
| Rate for Payer: TriWest Veterans Administration |
$61.16
|
| Rate for Payer: United Healthcare Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicare |
$61.16
|
| Rate for Payer: WINHealth Partners Commercial |
$88.04
|
| Rate for Payer: Wise Provider Network Commercial |
$88.04
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [138611]
|
Facility
|
OP
|
$628.72
|
|
|
Service Code
|
NDC 0006412101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$346.42 |
| Max. Negotiated Rate |
$628.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.15
|
| Rate for Payer: Aetna of WY Medicare |
$414.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.57
|
| Rate for Payer: Altius Commercial |
$603.57
|
| Rate for Payer: Beech Street Commercial |
$616.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.18
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.86
|
| Rate for Payer: Cigna of WY Commercial |
$616.15
|
| Rate for Payer: Entrust Commercial |
$597.28
|
| Rate for Payer: First Choice Health Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$364.66
|
| Rate for Payer: HealthUtah PPO |
$628.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.86
|
| Rate for Payer: Multiplan Medicare/VA |
$346.42
|
| Rate for Payer: One Health Plan of WY PPO |
$616.15
|
| Rate for Payer: PacificSource Commercial |
$565.85
|
| Rate for Payer: PHCS PPO |
$616.15
|
| Rate for Payer: Three Rivers PPO |
$471.54
|
| Rate for Payer: TriWest Veterans Administration |
$364.66
|
| Rate for Payer: United Healthcare Commercial |
$546.99
|
| Rate for Payer: United Healthcare Medicare |
$364.66
|
| Rate for Payer: WINHealth Partners Commercial |
$616.15
|
| Rate for Payer: Wise Provider Network Commercial |
$597.28
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [138611]
|
Facility
|
IP
|
$628.72
|
|
|
Service Code
|
NDC 0006412102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$394.21 |
| Max. Negotiated Rate |
$628.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.57
|
| Rate for Payer: Altius Commercial |
$603.57
|
| Rate for Payer: Beech Street Commercial |
$616.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.18
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.86
|
| Rate for Payer: Cigna of WY Commercial |
$616.15
|
| Rate for Payer: Entrust Commercial |
$597.28
|
| Rate for Payer: First Choice Health Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.96
|
| Rate for Payer: HealthUtah PPO |
$628.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.86
|
| Rate for Payer: Multiplan Medicare/VA |
$394.21
|
| Rate for Payer: One Health Plan of WY PPO |
$616.15
|
| Rate for Payer: PacificSource Commercial |
$565.85
|
| Rate for Payer: PHCS PPO |
$616.15
|
| Rate for Payer: Three Rivers PPO |
$471.54
|
| Rate for Payer: TriWest Veterans Administration |
$414.96
|
| Rate for Payer: United Healthcare Commercial |
$546.99
|
| Rate for Payer: United Healthcare Medicare |
$414.96
|
| Rate for Payer: WINHealth Partners Commercial |
$597.28
|
| Rate for Payer: Wise Provider Network Commercial |
$597.28
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [138611]
|
Facility
|
IP
|
$628.72
|
|
|
Service Code
|
NDC 0006412101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$394.21 |
| Max. Negotiated Rate |
$628.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.15
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.57
|
| Rate for Payer: Altius Commercial |
$603.57
|
| Rate for Payer: Beech Street Commercial |
$616.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.18
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.86
|
| Rate for Payer: Cigna of WY Commercial |
$616.15
|
| Rate for Payer: Entrust Commercial |
$597.28
|
| Rate for Payer: First Choice Health Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$414.96
|
| Rate for Payer: HealthUtah PPO |
$628.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.86
|
| Rate for Payer: Multiplan Medicare/VA |
$394.21
|
| Rate for Payer: One Health Plan of WY PPO |
$616.15
|
| Rate for Payer: PacificSource Commercial |
$565.85
|
| Rate for Payer: PHCS PPO |
$616.15
|
| Rate for Payer: Three Rivers PPO |
$471.54
|
| Rate for Payer: TriWest Veterans Administration |
$414.96
|
| Rate for Payer: United Healthcare Commercial |
$546.99
|
| Rate for Payer: United Healthcare Medicare |
$414.96
|
| Rate for Payer: WINHealth Partners Commercial |
$597.28
|
| Rate for Payer: Wise Provider Network Commercial |
$597.28
|
|
|
HUMAN PAPILLOMAVIRUS VACCINE,9-VALENT(PF) 0.5 ML INTRAMUSCULAR SYRINGE [138611]
|
Facility
|
OP
|
$628.72
|
|
|
Service Code
|
NDC 0006412102
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$346.42 |
| Max. Negotiated Rate |
$628.72 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$616.15
|
| Rate for Payer: Aetna of WY Medicare |
$414.96
|
| Rate for Payer: Altius Auto/Workers Compensation |
$603.57
|
| Rate for Payer: Altius Commercial |
$603.57
|
| Rate for Payer: Beech Street Commercial |
$616.15
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$516.18
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: ChoiceCare Network Commercial |
$609.86
|
| Rate for Payer: Cigna of WY Commercial |
$616.15
|
| Rate for Payer: Entrust Commercial |
$597.28
|
| Rate for Payer: First Choice Health Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$597.28
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$364.66
|
| Rate for Payer: HealthUtah PPO |
$628.72
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$609.86
|
| Rate for Payer: Multiplan Medicare/VA |
$346.42
|
| Rate for Payer: One Health Plan of WY PPO |
$616.15
|
| Rate for Payer: PacificSource Commercial |
$565.85
|
| Rate for Payer: PHCS PPO |
$616.15
|
| Rate for Payer: Three Rivers PPO |
$471.54
|
| Rate for Payer: TriWest Veterans Administration |
$364.66
|
| Rate for Payer: United Healthcare Commercial |
$546.99
|
| Rate for Payer: United Healthcare Medicare |
$364.66
|
| Rate for Payer: WINHealth Partners Commercial |
$616.15
|
| Rate for Payer: Wise Provider Network Commercial |
$597.28
|
|
|
HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION [183437]
|
Facility
|
IP
|
$11.81
|
|
|
Service Code
|
HCPCS C9159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.34
|
| Rate for Payer: Altius Commercial |
$11.34
|
| Rate for Payer: Beech Street Commercial |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.70
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.46
|
| Rate for Payer: Cigna of WY Commercial |
$11.57
|
| Rate for Payer: Entrust Commercial |
$11.22
|
| Rate for Payer: First Choice Health Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.79
|
| Rate for Payer: HealthUtah PPO |
$11.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.46
|
| Rate for Payer: Multiplan Medicare/VA |
$7.40
|
| Rate for Payer: One Health Plan of WY PPO |
$11.57
|
| Rate for Payer: PacificSource Commercial |
$10.63
|
| Rate for Payer: PHCS PPO |
$11.57
|
| Rate for Payer: Three Rivers PPO |
$8.86
|
| Rate for Payer: TriWest Veterans Administration |
$7.79
|
| Rate for Payer: United Healthcare Commercial |
$10.27
|
| Rate for Payer: United Healthcare Medicare |
$7.79
|
| Rate for Payer: WINHealth Partners Commercial |
$11.22
|
| Rate for Payer: Wise Provider Network Commercial |
$11.22
|
|
|
HUMAN PROTHROMBIN CMPLX CONCENTRATE (PCC)-LANS 1,000 UNIT IV SOLUTION [183437]
|
Facility
|
OP
|
$11.81
|
|
|
Service Code
|
HCPCS C9159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.57
|
| Rate for Payer: Aetna of WY Medicare |
$7.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.34
|
| Rate for Payer: Altius Commercial |
$11.34
|
| Rate for Payer: Beech Street Commercial |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.70
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.46
|
| Rate for Payer: Cigna of WY Commercial |
$11.57
|
| Rate for Payer: Entrust Commercial |
$11.22
|
| Rate for Payer: First Choice Health Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.85
|
| Rate for Payer: HealthUtah PPO |
$11.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.46
|
| Rate for Payer: Multiplan Medicare/VA |
$6.51
|
| Rate for Payer: One Health Plan of WY PPO |
$11.57
|
| Rate for Payer: PacificSource Commercial |
$10.63
|
| Rate for Payer: PHCS PPO |
$11.57
|
| Rate for Payer: Three Rivers PPO |
$8.86
|
| Rate for Payer: TriWest Veterans Administration |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$10.27
|
| Rate for Payer: United Healthcare Medicare |
$6.85
|
| Rate for Payer: WINHealth Partners Commercial |
$11.57
|
| Rate for Payer: Wise Provider Network Commercial |
$11.22
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION [183438]
|
Facility
|
IP
|
$11.81
|
|
|
Service Code
|
NDC 6898226101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.57
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.34
|
| Rate for Payer: Altius Commercial |
$11.34
|
| Rate for Payer: Beech Street Commercial |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.70
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.46
|
| Rate for Payer: Cigna of WY Commercial |
$11.57
|
| Rate for Payer: Entrust Commercial |
$11.22
|
| Rate for Payer: First Choice Health Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$7.79
|
| Rate for Payer: HealthUtah PPO |
$11.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.46
|
| Rate for Payer: Multiplan Medicare/VA |
$7.40
|
| Rate for Payer: One Health Plan of WY PPO |
$11.57
|
| Rate for Payer: PacificSource Commercial |
$10.63
|
| Rate for Payer: PHCS PPO |
$11.57
|
| Rate for Payer: Three Rivers PPO |
$8.86
|
| Rate for Payer: TriWest Veterans Administration |
$7.79
|
| Rate for Payer: United Healthcare Commercial |
$10.27
|
| Rate for Payer: United Healthcare Medicare |
$7.79
|
| Rate for Payer: WINHealth Partners Commercial |
$11.22
|
| Rate for Payer: Wise Provider Network Commercial |
$11.22
|
|
|
HUMAN PROTHROMBIN COMPLEX CONCENTRATE (PCC)-LANS 500 UNIT IV SOLUTION [183438]
|
Facility
|
OP
|
$11.81
|
|
|
Service Code
|
NDC 6898226101
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$11.81 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$11.57
|
| Rate for Payer: Aetna of WY Medicare |
$7.79
|
| Rate for Payer: Altius Auto/Workers Compensation |
$11.34
|
| Rate for Payer: Altius Commercial |
$11.34
|
| Rate for Payer: Beech Street Commercial |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$9.70
|
| Rate for Payer: Cash Price |
$8.27
|
| Rate for Payer: ChoiceCare Network Commercial |
$11.46
|
| Rate for Payer: Cigna of WY Commercial |
$11.57
|
| Rate for Payer: Entrust Commercial |
$11.22
|
| Rate for Payer: First Choice Health Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$11.22
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$6.85
|
| Rate for Payer: HealthUtah PPO |
$11.81
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$11.46
|
| Rate for Payer: Multiplan Medicare/VA |
$6.51
|
| Rate for Payer: One Health Plan of WY PPO |
$11.57
|
| Rate for Payer: PacificSource Commercial |
$10.63
|
| Rate for Payer: PHCS PPO |
$11.57
|
| Rate for Payer: Three Rivers PPO |
$8.86
|
| Rate for Payer: TriWest Veterans Administration |
$6.85
|
| Rate for Payer: United Healthcare Commercial |
$10.27
|
| Rate for Payer: United Healthcare Medicare |
$6.85
|
| Rate for Payer: WINHealth Partners Commercial |
$11.57
|
| Rate for Payer: Wise Provider Network Commercial |
$11.22
|
|
|
HYALGAN SUPARTZ VISCO-3 DOSE
|
Professional
|
Both
|
$667.00
|
|
|
Service Code
|
HCPCS J7321
|
| Hospital Charge Code |
J7321
|
| Min. Negotiated Rate |
$62.15 |
| Max. Negotiated Rate |
$667.00 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$653.66
|
| Rate for Payer: Aetna of WY Medicare |
$73.12
|
| Rate for Payer: Beech Street Commercial |
$633.65
|
| Rate for Payer: Cash Price |
$466.90
|
| Rate for Payer: Cash Price |
$466.90
|
| Rate for Payer: ChoiceCare Network Commercial |
$646.99
|
| Rate for Payer: Cigna of WY Commercial |
$653.66
|
| Rate for Payer: First Choice Health Commercial |
$600.30
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$633.65
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$73.12
|
| Rate for Payer: HealthUtah PPO |
$667.00
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$646.99
|
| Rate for Payer: Multiplan Medicare/VA |
$62.15
|
| Rate for Payer: One Health Plan of WY PPO |
$653.66
|
| Rate for Payer: PacificSource Commercial |
$600.30
|
| Rate for Payer: PHCS PPO |
$633.65
|
| Rate for Payer: Three Rivers PPO |
$500.25
|
| Rate for Payer: TriWest Veterans Administration |
$73.12
|
| Rate for Payer: United Healthcare Commercial |
$580.29
|
| Rate for Payer: United Healthcare Medicare |
$73.12
|
| Rate for Payer: WINHealth Partners Commercial |
$633.65
|
|
|
HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE [127392]
|
Facility
|
IP
|
$398.33
|
|
|
Service Code
|
HCPCS J7326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$249.75 |
| Max. Negotiated Rate |
$398.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$390.36
|
| Rate for Payer: Altius Auto/Workers Compensation |
$382.40
|
| Rate for Payer: Altius Commercial |
$382.40
|
| Rate for Payer: Beech Street Commercial |
$390.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.03
|
| Rate for Payer: Cash Price |
$278.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$386.38
|
| Rate for Payer: Cigna of WY Commercial |
$390.36
|
| Rate for Payer: Entrust Commercial |
$378.41
|
| Rate for Payer: First Choice Health Commercial |
$378.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$378.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$262.90
|
| Rate for Payer: HealthUtah PPO |
$398.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$386.38
|
| Rate for Payer: Multiplan Medicare/VA |
$249.75
|
| Rate for Payer: One Health Plan of WY PPO |
$390.36
|
| Rate for Payer: PacificSource Commercial |
$358.50
|
| Rate for Payer: PHCS PPO |
$390.36
|
| Rate for Payer: Three Rivers PPO |
$298.75
|
| Rate for Payer: TriWest Veterans Administration |
$262.90
|
| Rate for Payer: United Healthcare Commercial |
$346.55
|
| Rate for Payer: United Healthcare Medicare |
$262.90
|
| Rate for Payer: WINHealth Partners Commercial |
$378.41
|
| Rate for Payer: Wise Provider Network Commercial |
$378.41
|
|
|
HYALURONATE SODIUM, CROSS-LINKED 30 MG/3 ML INTRA-ARTICULAR SYRINGE [127392]
|
Facility
|
OP
|
$398.33
|
|
|
Service Code
|
HCPCS J7326
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$398.33 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$390.36
|
| Rate for Payer: Aetna of WY Medicare |
$262.90
|
| Rate for Payer: Altius Auto/Workers Compensation |
$382.40
|
| Rate for Payer: Altius Commercial |
$382.40
|
| Rate for Payer: Beech Street Commercial |
$390.36
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$327.03
|
| Rate for Payer: Cash Price |
$278.83
|
| Rate for Payer: ChoiceCare Network Commercial |
$386.38
|
| Rate for Payer: Cigna of WY Commercial |
$390.36
|
| Rate for Payer: Entrust Commercial |
$378.41
|
| Rate for Payer: First Choice Health Commercial |
$378.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$378.41
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$231.03
|
| Rate for Payer: HealthUtah PPO |
$398.33
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$386.38
|
| Rate for Payer: Multiplan Medicare/VA |
$219.48
|
| Rate for Payer: One Health Plan of WY PPO |
$390.36
|
| Rate for Payer: PacificSource Commercial |
$358.50
|
| Rate for Payer: PHCS PPO |
$390.36
|
| Rate for Payer: Three Rivers PPO |
$298.75
|
| Rate for Payer: TriWest Veterans Administration |
$231.03
|
| Rate for Payer: United Healthcare Commercial |
$346.55
|
| Rate for Payer: United Healthcare Medicare |
$231.03
|
| Rate for Payer: WINHealth Partners Commercial |
$390.36
|
| Rate for Payer: Wise Provider Network Commercial |
$378.41
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML INTRA-ARTICULAR SYRINGE [150942]
|
Facility
|
IP
|
$386.67
|
|
|
Service Code
|
HCPCS J7318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$242.44 |
| Max. Negotiated Rate |
$386.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$378.94
|
| Rate for Payer: Altius Auto/Workers Compensation |
$371.20
|
| Rate for Payer: Altius Commercial |
$371.20
|
| Rate for Payer: Beech Street Commercial |
$378.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$317.46
|
| Rate for Payer: Cash Price |
$270.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.07
|
| Rate for Payer: Cigna of WY Commercial |
$378.94
|
| Rate for Payer: Entrust Commercial |
$367.34
|
| Rate for Payer: First Choice Health Commercial |
$367.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$255.20
|
| Rate for Payer: HealthUtah PPO |
$386.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.07
|
| Rate for Payer: Multiplan Medicare/VA |
$242.44
|
| Rate for Payer: One Health Plan of WY PPO |
$378.94
|
| Rate for Payer: PacificSource Commercial |
$348.00
|
| Rate for Payer: PHCS PPO |
$378.94
|
| Rate for Payer: Three Rivers PPO |
$290.00
|
| Rate for Payer: TriWest Veterans Administration |
$255.20
|
| Rate for Payer: United Healthcare Commercial |
$336.40
|
| Rate for Payer: United Healthcare Medicare |
$255.20
|
| Rate for Payer: WINHealth Partners Commercial |
$367.34
|
| Rate for Payer: Wise Provider Network Commercial |
$367.34
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML INTRA-ARTICULAR SYRINGE [150942]
|
Facility
|
OP
|
$386.67
|
|
|
Service Code
|
HCPCS J7318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$213.06 |
| Max. Negotiated Rate |
$386.67 |
| Rate for Payer: Aetna of WY Commercial/Medical Rental |
$378.94
|
| Rate for Payer: Aetna of WY Medicare |
$255.20
|
| Rate for Payer: Altius Auto/Workers Compensation |
$371.20
|
| Rate for Payer: Altius Commercial |
$371.20
|
| Rate for Payer: Beech Street Commercial |
$378.94
|
| Rate for Payer: Blue Cross Blue Shield of Wyoming Commercial |
$317.46
|
| Rate for Payer: Cash Price |
$270.67
|
| Rate for Payer: ChoiceCare Network Commercial |
$375.07
|
| Rate for Payer: Cigna of WY Commercial |
$378.94
|
| Rate for Payer: Entrust Commercial |
$367.34
|
| Rate for Payer: First Choice Health Commercial |
$367.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Commercial |
$367.34
|
| Rate for Payer: Government Employees Health Association (GEHA) Medicare |
$224.27
|
| Rate for Payer: HealthUtah PPO |
$386.67
|
| Rate for Payer: Idaho Integrated Healthcare Commercial |
$375.07
|
| Rate for Payer: Multiplan Medicare/VA |
$213.06
|
| Rate for Payer: One Health Plan of WY PPO |
$378.94
|
| Rate for Payer: PacificSource Commercial |
$348.00
|
| Rate for Payer: PHCS PPO |
$378.94
|
| Rate for Payer: Three Rivers PPO |
$290.00
|
| Rate for Payer: TriWest Veterans Administration |
$224.27
|
| Rate for Payer: United Healthcare Commercial |
$336.40
|
| Rate for Payer: United Healthcare Medicare |
$224.27
|
| Rate for Payer: WINHealth Partners Commercial |
$378.94
|
| Rate for Payer: Wise Provider Network Commercial |
$367.34
|
|
